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General NPI Number Information
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NPI Number | 1629196217
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Entity Type | Organization
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Legal Business Name | CONSTANT LU DDS, PC.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 3205 NE 78TH ST SUITE 11
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City | VANCOUVER
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State | WA
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Zip | 98665-0697
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Country | US
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Telephone | 360-576-3570
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Fax |
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Provider Business Mailing Address
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Address Line | 3205 NE 78TH ST SUITE 11
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City | VANCOUVER
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State | WA
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Zip | 98665-0697
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Country | US
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Telephone | 360-576-3570
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CONSTANT E. LU
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Credential | DDS
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Telephone | 360-576-3570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7444
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License Number State | WA
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