Provider Demographics
NPI:1972787133
Name:LUO, DAVID TSUNOYU (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:TSUNOYU
Last Name:LUO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:T
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3810 MOSSY WAY CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-3835
Mailing Address - Country:US
Mailing Address - Phone:732-809-4349
Mailing Address - Fax:
Practice Address - Street 1:11841 PALM BEACH BLVD UNIT 115
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5914
Practice Address - Country:US
Practice Address - Phone:239-694-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0416501223G0001X
FL224651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01431305Medicaid