MEDICARE: DINH KHANH LUC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D12179	OR

General Provider Information

NPI Number	:	1588369946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINH KHANH LUC

Provider Business Mailing Address
First Line	:	5135 SKYLINE RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-9427
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5135 SKYLINE RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-9427
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	01/13/2026

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Directions to “ DINH KHANH LUC ” Practice Location

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