Provider Demographics
NPI:1780300749
Name:LUONG, TUAN ANH (DDS)
Entity type:Individual
Prefix:DR
First Name:TUAN
Middle Name:ANH
Last Name:LUONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TUAN
Other - Middle Name:ANH
Other - Last Name:LUONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1712 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3740
Mailing Address - Country:US
Mailing Address - Phone:972-971-7079
Mailing Address - Fax:
Practice Address - Street 1:1712 ALPINE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-3740
Practice Address - Country:US
Practice Address - Phone:972-971-7079
Practice Address - Fax:972-939-6627
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist