MEDICARE: DR. YAN LU DDS

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	21908	MA

General Provider Information

NPI Number	:	1851590384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAN LU DDS

Provider Business Mailing Address
First Line	:	PO BOX 4126
Second Line	:
City	:	ANDOVER
State	:	MA
Zip	:	01810-0812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	66T CONCORD ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2179
Country	:	US
Telephone Number	:	978-694-1090
Fax Number	:

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

Provider Enumeration Date	:	07/14/2007
Last Update Date	:	02/07/2017

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