Provider Demographics
NPI:1255667382
Name:NHIEN LUU, D.D.S., INC.
Entity Type:Organization
Organization Name:NHIEN LUU, D.D.S., INC.
Other - Org Name:MAPLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NHIEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-949-7274
Mailing Address - Street 1:14466 MAIN ST
Mailing Address - Street 2:SUITE B107
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4664
Mailing Address - Country:US
Mailing Address - Phone:760-949-7274
Mailing Address - Fax:760-949-9515
Practice Address - Street 1:14466 MAIN ST
Practice Address - Street 2:SUITE B107
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4664
Practice Address - Country:US
Practice Address - Phone:760-949-7274
Practice Address - Fax:760-949-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-24
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104080167OtherINDIVIDUAL NPI