Provider Demographics
NPI:1548377922
Name:RIAO-LUQUE DENTAL CORP
Entity type:Organization
Organization Name:RIAO-LUQUE DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMILO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-573-5182
Mailing Address - Street 1:3532 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2419
Mailing Address - Country:US
Mailing Address - Phone:415-573-5182
Mailing Address - Fax:415-643-6424
Practice Address - Street 1:3532 20TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2419
Practice Address - Country:US
Practice Address - Phone:415-573-5182
Practice Address - Fax:415-643-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483211223G0001X, 1223S0112X
CA516431223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty