Basic Information
| Provider Information | |||||||||
| NPI: | 1306299433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUO | ||||||||
| FirstName: | JING | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 871 HUFFMAN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274057205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362300346 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 871 HUFFMAN ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274057205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362300346 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2016 | ||||||||
| LastUpdateDate: | 07/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 10461 | NC | Y | Dental Providers | Dentist | General Practice |
No ID Information.