Healthcare Provider Details

I. General information

NPI: 1538091905
Provider Name (Legal Business Name): LUNA DENTAL SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9203 LEE HWY STE 16
OOLTEWAH TN
37363-6459
US

IV. Provider business mailing address

9203 LEE HWY STE 16
OOLTEWAH TN
37363-6459
US

V. Phone/Fax

Practice location:
  • Phone: 423-414-3632
  • Fax:
Mailing address:
  • Phone: 423-414-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: RUCHI MUKESH PATEL
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 423-310-0075