Provider Demographics
NPI:1487858585
Name:LITONJUA, LUIS (DMD, DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:LITONJUA
Suffix:
Gender:M
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28900 LANCASTER ST
Mailing Address - Street 2:APT. 48
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3861
Mailing Address - Country:US
Mailing Address - Phone:734-765-7525
Mailing Address - Fax:
Practice Address - Street 1:2700 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:DEPT. OF PERIODONTICS
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2576
Practice Address - Country:US
Practice Address - Phone:313-494-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010194871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics