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General NPI Number Information
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NPI Number | 1114305075
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Entity Type | Organization
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Legal Business Name | LUU DENTAL CORPORATION
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 985 S SANTA FE AVE STE 5
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City | VISTA
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State | CA
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Zip | 92083-6912
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Country | US
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Telephone | 760-295-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 985 S SANTA FE AVE STE 5
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City | VISTA
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State | CA
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Zip | 92083-6912
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Country | US
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Telephone | 760-295-1778
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CINDY THOA LUU
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Credential | DDS
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Telephone | 760-295-1778
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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 | 53084
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License Number State | CA
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