Provider Demographics
NPI:1043305519
Name:LUQUE, ANGELA M (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:LUQUE
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 1:114 SILVERADO CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1023
Mailing Address - Country:US
Mailing Address - Phone:916-267-7922
Mailing Address - Fax:
Practice Address - Street 1:114 SILVERADO CIR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1023
Practice Address - Country:US
Practice Address - Phone:916-267-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice