Healthcare Provider Details

I. General information

NPI: 1871211342
Provider Name (Legal Business Name): TRISHA NGUYEN-LUU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2715
US

IV. Provider business mailing address

401 N CORTEZ ST APT 2115
NEW ORLEANS LA
70119-4841
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8390
  • Fax:
Mailing address:
  • Phone: 213-605-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberS-1109
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: