Healthcare Provider Details

I. General information

NPI: 1043468457
Provider Name (Legal Business Name): EUGENE P LUNA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 GEORGIA ST
VALLEJO CA
94590-6004
US

IV. Provider business mailing address

PO BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 707-558-2000
  • Fax: 707-644-3507
Mailing address:
  • Phone: 510-535-4000
  • Fax: 510-535-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number57598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: