Provider Demographics
NPI:1093200917
Name:LUO, MINOU (DMD)
Entity type:Individual
Prefix:DR
First Name:MINOU
Middle Name:
Last Name:LUO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROMEO
Other - Middle Name:
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1075 BERKSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1264
Mailing Address - Country:US
Mailing Address - Phone:610-374-4093
Mailing Address - Fax:
Practice Address - Street 1:1075 BERKSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1264
Practice Address - Country:US
Practice Address - Phone:610-374-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0440131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program