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General NPI Number Information
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NPI Number | 1477112621
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Entity Type | Individual
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Provider Name | LAWRENCE SONGYUAN LU DDS
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Gender | Male
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1421 ARMOUR ST
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City | CHATTANOOGA
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State | TN
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Zip | 37412-2812
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Country | US
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Telephone | 423-458-6326
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Fax | 423-629-5278
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Provider Business Mailing Address
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Address Line | 7710 ASPEN LODGE WAY APT 420
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4121
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Country | US
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Telephone | 731-819-6248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11051
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License Number State | TN
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