Provider Demographics
NPI:1104226638
Name:HOUSE, LUZ (DDS)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 135TH ST
Mailing Address - Street 2:APT 709
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1050
Mailing Address - Country:US
Mailing Address - Phone:917-684-1113
Mailing Address - Fax:
Practice Address - Street 1:619 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4553
Practice Address - Country:US
Practice Address - Phone:516-572-1300
Practice Address - Fax:516-566-3954
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63924122300000X
NY0592161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty