Healthcare Provider Details

I. General information

NPI: 1114137833
Provider Name (Legal Business Name): DR. KEITH JAMES LUMINAIS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 AUSTIN ST
BOGALUSA LA
70427-3857
US

IV. Provider business mailing address

320 AUSTIN ST
BOGALUSA LA
70427-3857
US

V. Phone/Fax

Practice location:
  • Phone: 985-735-7653
  • Fax: 985-735-7688
Mailing address:
  • Phone: 985-735-7653
  • Fax: 985-735-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5809
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: