Provider Demographics
NPI:1407114481
Name:LUA FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:LUA FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LUA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-813-3699
Mailing Address - Street 1:1101 SOUTH GLENDORA AVE.
Mailing Address - Street 2:SUITE #A
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-813-3699
Mailing Address - Fax:626-813-3769
Practice Address - Street 1:1101 SOUTH GLENDORA AVE.
Practice Address - Street 2:SUITE #A
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-813-3699
Practice Address - Fax:626-813-3769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty