Provider Demographics
NPI:1467705533
Name:ERIC D. LUU & LISA M. NGUYEN
Entity Type:Organization
Organization Name:ERIC D. LUU & LISA M. NGUYEN
Other - Org Name:MINT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-292-5231
Mailing Address - Street 1:87 FENTON ST
Mailing Address - Street 2:STE 105
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4100
Mailing Address - Country:US
Mailing Address - Phone:925-292-5231
Mailing Address - Fax:
Practice Address - Street 1:87 FENTON ST
Practice Address - Street 2:STE 105
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4100
Practice Address - Country:US
Practice Address - Phone:925-292-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA576691223G0001X
CA587271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty