Provider Demographics
NPI:1477620631
Name:LUU, MATHEW T (DDS)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:T
Last Name:LUU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9448 MAGNOLIA AVE
Mailing Address - Street 2:A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3746
Mailing Address - Country:US
Mailing Address - Phone:951-343-0123
Mailing Address - Fax:
Practice Address - Street 1:9448 MAGNOLIA AVE
Practice Address - Street 2:A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3746
Practice Address - Country:US
Practice Address - Phone:951-343-0123
Practice Address - Fax:951-343-0268
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice