Healthcare Provider Details

I. General information

NPI: 1952004228
Provider Name (Legal Business Name): LUX DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 HIGHLAND RD
WATERFORD MI
48328-1222
US

IV. Provider business mailing address

4470 HIGHLAND RD
WATERFORD MI
48328-1222
US

V. Phone/Fax

Practice location:
  • Phone: 248-275-3244
  • Fax:
Mailing address:
  • Phone: 248-275-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SONYA MANSOUR
Title or Position: MANAGER
Credential:
Phone: 586-843-6474