MEDICARE: DR. JUDY TRINH LUU DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN19665	FL

General Provider Information

NPI Number	:	1720208648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY TRINH LUU DMD

Provider Business Mailing Address
First Line	:	449 S 12TH ST
Second Line	:	UNIT 2802
City	:	TAMPA
State	:	FL
Zip	:	33602-5606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12813 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2803
Country	:	US
Telephone Number	:	813-280-0687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	12/07/2016

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