Provider Demographics
NPI:1235862723
Name:LUONG, ANTHONY LE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LE
Last Name:LUONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8061 DARIEN CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-5533
Mailing Address - Country:US
Mailing Address - Phone:408-966-8017
Mailing Address - Fax:
Practice Address - Street 1:140 HIDDEN VALLEY PKWY STE K
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-4002
Practice Address - Country:US
Practice Address - Phone:951-898-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1075761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice