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General NPI Number Information
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NPI Number | 1831530187
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Entity Type | Individual
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Provider Name | KHANH V LUONG DDS
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Gender | Male
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 40TH & HOLDREGE STREET ORTHODONTIC DEPARTMENT
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City | LINCOLN
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State | NE
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Zip | 68583-0740
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Country | US
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Telephone | 337-296-1045
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Fax |
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Provider Business Mailing Address
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Address Line | 2911 FLETCHER AVE APT 126
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City | LINCOLN
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State | NE
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Zip | 68504-1011
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Country | US
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Telephone | 337-296-1045
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6363
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License Number State | LA
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