Provider Demographics
NPI:1689825176
Name:LUONG, MARIA TRINH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TRINH
Last Name:LUONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E BURLEIGH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2403
Mailing Address - Country:US
Mailing Address - Phone:352-253-6400
Mailing Address - Fax:352-253-6401
Practice Address - Street 1:215 E BURLEIGH BLVD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2403
Practice Address - Country:US
Practice Address - Phone:352-253-6400
Practice Address - Fax:352-253-6401
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice