Healthcare Provider Details

I. General information

NPI: 1538378179
Provider Name (Legal Business Name): JEFFERY ROBERT LUZAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 S MAIN ST SUITE 204
ORANGE CA
92868-3833
US

IV. Provider business mailing address

427 N JANSS ST
ANAHEIM CA
92805-2528
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-8801
  • Fax: 714-744-8629
Mailing address:
  • Phone: 949-228-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: