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General NPI Number Information
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NPI Number | 1437646379
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Entity Type | Organization
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Legal Business Name | ELIZABETH LUONG DDS INC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 1747 CREEKSIDE DR STE 100
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City | FOLSOM
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State | CA
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Zip | 95630-3928
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Country | US
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Telephone | 916-467-7920
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Fax |
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Provider Business Mailing Address
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Address Line | 1747 CREEKSIDE DR STE 100
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City | FOLSOM
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State | CA
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Zip | 95630-3928
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Country | US
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Telephone | 916-467-7920
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ELIZABETH LUONG
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Credential | DMD
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Telephone | 415-513-3792
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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 | 100585
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License Number State | CA
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