MEDICARE: LUMINA DENTAL STUDIO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1427912369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINA DENTAL STUDIO LLC

Provider Business Mailing Address
First Line	:	1401 E ATLANTIC BLVD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6746
Country	:	US
Telephone Number	:	954-960-6089
Fax Number	:	954-820-6089

Provider Business Practice Location Address
First Line	:	1401 E ATLANTIC BLVD
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6746
Country	:	US
Telephone Number	:	954-960-6089
Fax Number	:	954-820-6089

Authorized Official
Title or Position	:	GENERAL DENTIST / OWNER
Name	:	CYNTHIA ALFONSO CAMACHO
Credential	:	DMD
Telephone Number	:	954-960-6089

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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