Healthcare Provider Details

I. General information

NPI: 1124945662
Provider Name (Legal Business Name): REFUGIO LUNA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 BASELINE ST
CORNELIUS OR
97113-8312
US

IV. Provider business mailing address

18412 SW SILVERTIP ST
BEAVERTON OR
97007-3004
US

V. Phone/Fax

Practice location:
  • Phone: 503-359-0339
  • Fax:
Mailing address:
  • Phone: 415-743-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12356
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: