Provider Demographics
NPI:1558885897
Name:CHAU, LUAN CAO (DMD)
Entity type:Individual
Prefix:
First Name:LUAN
Middle Name:CAO
Last Name:CHAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S ACADEMY ST UNIT 1321
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-5050
Mailing Address - Country:US
Mailing Address - Phone:352-410-9000
Mailing Address - Fax:239-600-7872
Practice Address - Street 1:668 FAIRVIEW RD STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6708
Practice Address - Country:US
Practice Address - Phone:864-881-7098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22820122300000X
SC9296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist