Provider Demographics
NPI:1346291663
Name:LUQUE, DOLORES (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:
Last Name:LUQUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:MARIN
Other - Middle Name:DOLORES
Other - Last Name:WUILLEUMIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:BUILDING 171, 4TH & INNER LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-5076
Mailing Address - Country:US
Mailing Address - Phone:760-380-5733
Mailing Address - Fax:760-380-4996
Practice Address - Street 1:BUILDING 171, 4TH & INNER LOOP RD
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5076
Practice Address - Country:US
Practice Address - Phone:760-380-5733
Practice Address - Fax:760-380-4996
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051029-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice