Provider Demographics
NPI:1710569215
Name:ELIZABETH LUONG D.M.D. INC.
Entity Type:Organization
Organization Name:ELIZABETH LUONG D.M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-513-3792
Mailing Address - Street 1:810 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4320
Mailing Address - Country:US
Mailing Address - Phone:916-443-1905
Mailing Address - Fax:
Practice Address - Street 1:810 29TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4320
Practice Address - Country:US
Practice Address - Phone:916-443-1905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty