MEDICARE: LUNA DENTAL SPA

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	122300000X	Dentist

General Provider Information

NPI Number	:	1538091905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA DENTAL SPA

Provider Business Mailing Address
First Line	:	9203 LEE HWY STE 16
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6459
Country	:	US
Telephone Number	:	423-414-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	9203 LEE HWY STE 16
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6459
Country	:	US
Telephone Number	:	423-414-3632
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	RUCHI MUKESH PATEL
Credential	:	DMD
Telephone Number	:	423-310-0075

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “LUNA DENTAL SPA ” Practice Location

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