Healthcare Provider Details

I. General information

NPI: 1316167273
Provider Name (Legal Business Name): JOHN CHARLES LUOMANEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 BEAUCHAMP CT
SAN DIEGO CA
92130-2742
US

IV. Provider business mailing address

4970 BEAUCHAMP CT
SAN DIEGO CA
92130-2742
US

V. Phone/Fax

Practice location:
  • Phone: 858-775-4022
  • Fax: 858-755-3077
Mailing address:
  • Phone: 858-755-3077
  • Fax: 858-755-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number27028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: