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General NPI Number Information
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NPI Number | 1457864373
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Entity Type | Organization
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Legal Business Name | CU TU LU, DDS INC. A PROFESSIONAL DENTAL CORP.
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 515 E YOSEMITE AVE
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City | MADERA
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State | CA
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Zip | 93638-3334
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Country | US
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Telephone | 559-673-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 515 E YOSEMITE AVE
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City | MADERA
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State | CA
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Zip | 93638-3334
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CU TU LU
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Credential | DDS
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Telephone | 559-673-0199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 44928
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License Number State | CA
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