Provider Demographics
NPI:1437646379
Name:ELIZABETH LUONG DDS INC
Entity Type:Organization
Organization Name:ELIZABETH LUONG DDS INC
Other - Org Name:4.0 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-513-3792
Mailing Address - Street 1:1747 CREEKSIDE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3928
Mailing Address - Country:US
Mailing Address - Phone:916-467-7920
Mailing Address - Fax:
Practice Address - Street 1:1747 CREEKSIDE DR STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3928
Practice Address - Country:US
Practice Address - Phone:916-467-7920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA