MEDICARE: DR. GANG ANTHONY 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	1223G0001X	General Practice Dentistry	30025103	OH

General Provider Information

NPI Number	:	1508393422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GANG ANTHONY LU DMD

Provider Business Mailing Address
First Line	:	1110 EUCLID AVE STE 202
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1626
Country	:	US
Telephone Number	:	216-696-1441
Fax Number	:	216-803-2222

Provider Business Practice Location Address
First Line	:	1110 EUCLID AVE STE 202
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115
Country	:	US
Telephone Number	:	216-616-1155
Fax Number	:	216-803-2222

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

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	05/26/2026

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