Provider Demographics
NPI:1144655812
Name:LUU, THANH TRUNG (DDS)
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:TRUNG
Last Name:LUU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 RANCHO SANTA FE RD
Mailing Address - Street 2:#225
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8685
Mailing Address - Country:US
Mailing Address - Phone:951-333-5127
Mailing Address - Fax:
Practice Address - Street 1:7720 RANCHO SANTA FE RD
Practice Address - Street 2:#225
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8685
Practice Address - Country:US
Practice Address - Phone:951-333-5127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist