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General NPI Number Information
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NPI Number | 1013796986
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Entity Type | Organization
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Legal Business Name | LUX DENTAL
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 11/26/2023
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Provider Practice Location Address
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Address Line | 5050 W ATLANTIC AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8129
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Country | US
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Telephone | 917-533-7703
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 W ATLANTIC AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8129
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | YANA AVENILOV
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Credential |
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Telephone | 917-533-7703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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