Provider Demographics
NPI:1659545432
Name:CUA, LUZ O (DMD MS PC)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:O
Last Name:CUA
Suffix:
Gender:F
Credentials:DMD MS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 LAKE COOK RD STE 108
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1450
Mailing Address - Country:US
Mailing Address - Phone:847-564-3388
Mailing Address - Fax:847-564-3382
Practice Address - Street 1:1535 LAKE COOK RD STE 108
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1450
Practice Address - Country:US
Practice Address - Phone:847-564-3388
Practice Address - Fax:847-564-3382
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics