Healthcare Provider Details

I. General information

NPI: 1427912369
Provider Name (Legal Business Name): LUMINA DENTAL STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6746
US

IV. Provider business mailing address

1401 E ATLANTIC BLVD
POMPANO BEACH FL
33060-6746
US

V. Phone/Fax

Practice location:
  • Phone: 954-960-6089
  • Fax: 954-820-6089
Mailing address:
  • Phone: 954-960-6089
  • Fax: 954-820-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA ALFONSO CAMACHO
Title or Position: GENERAL DENTIST / OWNER
Credential: DMD
Phone: 954-960-6089