Provider Demographics
NPI:1780135657
Name:LU, JENNY (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNY
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 1:4225 SIENNA PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6024
Mailing Address - Country:US
Mailing Address - Phone:281-778-5330
Mailing Address - Fax:281-778-5350
Practice Address - Street 1:4225 SIENNA PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6024
Practice Address - Country:US
Practice Address - Phone:281-778-5330
Practice Address - Fax:281-778-5350
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist