Healthcare Provider Details

I. General information

NPI: 1902438682
Provider Name (Legal Business Name): LUMY DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 W 95TH ST
OAK LAWN IL
60453-7222
US

IV. Provider business mailing address

219 S ALDER CREEK DR
ROMEOVILLE IL
60446-5342
US

V. Phone/Fax

Practice location:
  • Phone: 331-233-1001
  • Fax: 331-233-1002
Mailing address:
  • Phone: 248-410-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOMAM W SAADI
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 331-233-1001