Provider Demographics
NPI:1538396833
Name:LU, CHENG-RU DAVID (DDS)
Entity type:Individual
Prefix:
First Name:CHENG-RU
Middle Name:DAVID
Last Name:LU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:CHENG-RU
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2441 N TUSTIN AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1661
Mailing Address - Country:US
Mailing Address - Phone:714-953-9952
Mailing Address - Fax:714-953-1790
Practice Address - Street 1:2441 N TUSTIN AVE
Practice Address - Street 2:SUITE J
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1661
Practice Address - Country:US
Practice Address - Phone:714-953-9952
Practice Address - Fax:714-953-1790
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice