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General NPI Number Information
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NPI Number | 1598205031
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Entity Type | Organization
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Legal Business Name | SHANE LU, D.D.S. PLLC
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 8620 CROWN CRESCENT CT
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City | CHARLOTTE
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State | NC
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Zip | 28227-6783
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Country | US
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Telephone | 704-256-5764
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Fax |
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Provider Business Mailing Address
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Address Line | 8620 CROWN CRESCENT CT
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City | CHARLOTTE
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State | NC
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Zip | 28227-6783
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Country | US
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Telephone | 704-256-5764
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. SHANE LU
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Credential | D.D.S.
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Telephone | 404-519-1385
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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 | 9969
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License Number State | NC
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