Provider Demographics
NPI:1588746804
Name:LU, ANNA (DMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1038 MURRIETA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4151
Mailing Address - Country:US
Mailing Address - Phone:925-447-4447
Mailing Address - Fax:925-447-7925
Practice Address - Street 1:1038 MURRIETA BLVD STE A
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4151
Practice Address - Country:US
Practice Address - Phone:925-447-4447
Practice Address - Fax:925-447-7925
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52423OtherLICENSE