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General NPI Number Information
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NPI Number | 1558872879
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Entity Type | Organization
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Legal Business Name | TREVOR D LUU DMD PC
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 06/27/2018
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Provider Practice Location Address
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Address Line | 8585 WESTMINSTER AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92844
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Country | US
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Telephone | 714-655-4405
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Fax | 714-281-8200
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Provider Business Mailing Address
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Address Line | 8585 WESTMINSTER AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92844-2501
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Country | US
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Telephone | 714-655-4405
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Fax | 714-281-8200
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Authorized Official
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Title or Position | OWNER
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Name | TREVOR DUC LUU
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Credential | DMD
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Telephone | 714-655-4405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 55535
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License Number State | CA
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