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General NPI Number Information
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NPI Number | 1073900858
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Entity Type | Organization
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Legal Business Name | THANH LUU AND TINA SAW DENTAL CORP
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 7720 RANCHO SANTA FE ROAD SUITE E
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City | CARLSBAD
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State | CA
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Zip | 92009
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Country | US
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Telephone | 951-333-5127
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Fax |
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Provider Business Mailing Address
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Address Line | 2480 1/2 MCKNIGHT DR
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City | LEMON GROVE
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State | CA
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Zip | 91945-3144
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Country | US
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Telephone | 951-333-5127
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | THANH LUU
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Credential | D.D.S.
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Telephone | 951-333-5127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 62972
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License Number State | CA
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