Provider Demographics
NPI:1275274474
Name:LU, KATHLEEN (DDS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 FENTON ST APT 510
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5044
Mailing Address - Country:US
Mailing Address - Phone:305-335-7299
Mailing Address - Fax:
Practice Address - Street 1:1286 E WEST HWY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3242
Practice Address - Country:US
Practice Address - Phone:301-761-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD184781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice