Provider Demographics
NPI:1164727905
Name:SUL, LUKE (DDS)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:SUL
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 1:22517 CELLO DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:928 S WESTERN AVE STE 231
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1083
Practice Address - Country:US
Practice Address - Phone:213-214-2875
Practice Address - Fax:213-214-2875
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60116OtherLICENCE NUMBER