Provider Demographics
NPI:1003343765
Name:LUNA-SALGUERO, ANTONIO (DDS)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:LUNA-SALGUERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 GATEWAY UNIT 1408
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1584
Mailing Address - Country:US
Mailing Address - Phone:949-307-6589
Mailing Address - Fax:
Practice Address - Street 1:7725 GATEWAY UNIT 1408
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1584
Practice Address - Country:US
Practice Address - Phone:949-307-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist