=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225825789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUX DENTAL AND SPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2025
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3603 PALM HARBOR BLVD STE A
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34683-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-724-4227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3603 PALM HARBOR BLVD STE A
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34683-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-724-4227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | MRS. ALENA KVASHENKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-724-4227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------