Provider Demographics
NPI:1063791366
Name:LU, VINA (DMD)
Entity type:Individual
Prefix:
First Name:VINA
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 NOTTINGHILL RD # 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-4026
Mailing Address - Country:US
Mailing Address - Phone:510-457-8168
Mailing Address - Fax:
Practice Address - Street 1:1026 ADELE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-2412
Practice Address - Country:US
Practice Address - Phone:510-457-8168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18558241223G0001X
TX297081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice