Healthcare Provider Details

I. General information

NPI: 1669728150
Provider Name (Legal Business Name): LUX COZY DENTAL SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34597 N. 60TH ST. #101
SCOTTSDALE AZ
85266
US

IV. Provider business mailing address

34597 N. 60TH ST. #101
SCOTTSDALE AZ
85266
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-9655
  • Fax: 480-575-1130
Mailing address:
  • Phone: 480-488-9655
  • Fax: 480-575-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008445
License Number StateAZ

VIII. Authorized Official

Name: MR. KEVIN CHO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 480-488-9655