Healthcare Provider Details

I. General information

NPI: 1710535349
Provider Name (Legal Business Name): DAVID NICHOLAS LUTHER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8804 HAWBUCK ST
TRINITY FL
34655-5360
US

IV. Provider business mailing address

8804 HAWBUCK ST
TRINITY FL
34655-5360
US

V. Phone/Fax

Practice location:
  • Phone: 727-478-3210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN23779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: