Provider Demographics
NPI:1235507237
Name:LUONG, GORDON GIA (DDS)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:GIA
Last Name:LUONG
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 1:9990 W 26TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1583
Mailing Address - Country:US
Mailing Address - Phone:303-232-4500
Mailing Address - Fax:303-232-8795
Practice Address - Street 1:9990 W 26TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1583
Practice Address - Country:US
Practice Address - Phone:303-232-4500
Practice Address - Fax:303-232-8795
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist