MEDICARE: DR. DAVID TSUNOYU LUO D.D.S.

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	1223G0001X	General Practice Dentistry	041650	NY
2	1223G0001X	General Practice Dentistry	22465	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972787133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID TSUNOYU LUO D.D.S.

Provider Business Mailing Address
First Line	:	3810 MOSSY WAY CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-3835
Country	:	US
Telephone Number	:	732-809-4349
Fax Number	:

Provider Business Practice Location Address
First Line	:	11841 PALM BEACH BLVD UNIT 115
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5914
Country	:	US
Telephone Number	:	239-694-7702
Fax Number	:

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	11/26/2019

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