Provider Demographics
NPI:1851545818
Name:LUAN, ALICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:
Last Name:LUAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAIN ST STE 307
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3230
Mailing Address - Country:US
Mailing Address - Phone:281-238-4746
Mailing Address - Fax:
Practice Address - Street 1:1601 MAIN ST STE 307
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3230
Practice Address - Country:US
Practice Address - Phone:281-238-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229351223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice