Provider Demographics
NPI:1346607314
Name:LUONG, QUANG
Entity Type:Individual
Prefix:
First Name:QUANG
Middle Name:
Last Name:LUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5297 S 31ST ST STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3515
Mailing Address - Country:US
Mailing Address - Phone:254-773-0055
Mailing Address - Fax:
Practice Address - Street 1:5297 S 31ST ST STE 111
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3515
Practice Address - Country:US
Practice Address - Phone:254-773-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2023-03-03
Deactivation Date:2022-11-02
Deactivation Code:
Reactivation Date:2022-11-07
Provider Licenses
StateLicense IDTaxonomies
TX31611122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Multi-Specialty