Healthcare Provider Details

I. General information

NPI: 1346159548
Provider Name (Legal Business Name): LUMA JABER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 PROSPERITY CHURCH RD
CHARLOTTE NC
28269-8113
US

IV. Provider business mailing address

1477 CAROLYN DR
CHARLOTTE NC
28205-5669
US

V. Phone/Fax

Practice location:
  • Phone: 704-352-3037
  • Fax:
Mailing address:
  • Phone: 704-352-3037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: