Provider Demographics
NPI:1598432015
Name:CAROL LUONG DMD PLLC
Entity Type:Organization
Organization Name:CAROL LUONG DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-359-0566
Mailing Address - Street 1:1043 CHATHAM DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-7730
Mailing Address - Country:US
Mailing Address - Phone:360-359-0566
Mailing Address - Fax:
Practice Address - Street 1:730 SLEATER KINNEY RD SE STE H
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1144
Practice Address - Country:US
Practice Address - Phone:360-491-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty