Provider Demographics
NPI:1336513050
Name:LUO, ANDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:LUO
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 1:1645 W OGDEN AVE UNIT 803
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4392
Mailing Address - Country:US
Mailing Address - Phone:714-300-8894
Mailing Address - Fax:
Practice Address - Street 1:12033 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1221
Practice Address - Country:US
Practice Address - Phone:708-371-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030513122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist