Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DENT.DE.60582333 | WA |
NPI | 1104292887 |
---|---|
Provider Name | Rita Lu |
First Address | Bellevue, WA 98006-2607 |
Second Address | Bellevue, WA 98006-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2015 |
Last Update Date | 17/08/2015 |