Provider Demographics
NPI:1548413586
Name:LUU, CUONG Q (DDS)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:Q
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 1:3701 88TH ST NE STE D
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7243
Mailing Address - Country:US
Mailing Address - Phone:360-925-6530
Mailing Address - Fax:
Practice Address - Street 1:3701 88TH ST NE STE D
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7243
Practice Address - Country:US
Practice Address - Phone:360-925-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600353501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5059134Medicaid