MEDICARE: LIFETIME DENTAL CARE

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	42062	CA

General Provider Information

NPI Number	:	1740201896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFETIME DENTAL CARE

Provider Business Mailing Address
First Line	:	1062 S DE ANZA BLVD STE C103
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3556
Country	:	US
Telephone Number	:	408-255-9666
Fax Number	:	408-255-4524

Provider Business Practice Location Address
First Line	:	1062 S DE ANZA BLVD STE C103
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3556
Country	:	US
Telephone Number	:	408-255-9666
Fax Number	:	408-255-4524

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WENDY C LU
Credential	:	DDS
Telephone Number	:	408-255-9666

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	02/25/2013

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Directions to “LIFETIME DENTAL CARE ” Practice Location

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