Provider Demographics
NPI:1720138233
Name:LUONG, CATHLEEN HUONG DIEM (DMD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN HUONG
Middle Name:DIEM
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 1:5820 S WILLIAMSON BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6400
Mailing Address - Country:US
Mailing Address - Phone:386-760-0366
Mailing Address - Fax:386-760-0793
Practice Address - Street 1:5820 S WILLIAMSON BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6400
Practice Address - Country:US
Practice Address - Phone:386-760-0366
Practice Address - Fax:386-760-0793
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice