Provider Demographics
NPI:1215691480
Name:MICHAEL LUONG PLLC
Entity type:Organization
Organization Name:MICHAEL LUONG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-310-3244
Mailing Address - Street 1:6410 83RD AVE C T W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PL
Mailing Address - State:WA
Mailing Address - Zip Code:98467
Mailing Address - Country:US
Mailing Address - Phone:206-310-3244
Mailing Address - Fax:
Practice Address - Street 1:2310 MILDRED ST W STE 132
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466-6055
Practice Address - Country:US
Practice Address - Phone:206-310-3244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty