Healthcare Provider Details

I. General information

NPI: 1780098293
Provider Name (Legal Business Name): LUMINT FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 KENDALE DR
DALLAS TX
75220-4736
US

IV. Provider business mailing address

2823 KENDALE DR
DALLAS TX
75220-4736
US

V. Phone/Fax

Practice location:
  • Phone: 214-350-8800
  • Fax:
Mailing address:
  • Phone: 214-350-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22755
License Number StateTX

VIII. Authorized Official

Name: LAN CHI LE
Title or Position: DENTIST
Credential:
Phone: 214-350-8800