Healthcare Provider Details

I. General information

NPI: 1144089962
Provider Name (Legal Business Name): LUNA SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHURCH ST STE 11
MOUNT LAUREL NJ
08054-2572
US

IV. Provider business mailing address

30 JACKSON RD STE B1
MEDFORD LAKES NJ
08055-9280
US

V. Phone/Fax

Practice location:
  • Phone: 856-866-5511
  • Fax:
Mailing address:
  • Phone: 609-953-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAJ DARJI
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 856-938-7606