MEDICARE: DR. HENRY J LU DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	31931	TX
2	1223G0001X	General Practice Dentistry	31931	TX

General Provider Information

NPI Number	:	1033561774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY J LU DMD

Provider Business Mailing Address
First Line	:	6108 SKILLMAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-7811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6108 SKILLMAN ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-7811
Country	:	US
Telephone Number	:	469-998-9822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	05/31/2023

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