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General NPI Number Information
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NPI Number | 1104982313
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Entity Type | Individual
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Provider Name | NICOLE N LUONG DDS
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Gender | Female
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 01/25/2014
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Provider Practice Location Address
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Address Line | 12720 SE STARK ST
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City | PORTLAND
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State | OR
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Zip | 97233-1539
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Country | US
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Telephone | 503-252-6133
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Fax | 503-257-6886
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Provider Business Mailing Address
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Address Line | 10232 SE CHAMPAGNE LN
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-7843
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Country | US
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Telephone | 503-708-8059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D7803
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License Number State | OR
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