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General NPI Number Information
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NPI Number | 1295053809
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Entity Type | Organization
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Legal Business Name | SERENITY DENTISTRY SPA, LLC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 972 DEL MAR DR
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City | LADY LAKE
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State | FL
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Zip | 32159-7705
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Country | US
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Telephone | 352-350-1933
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Fax |
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Provider Business Mailing Address
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Address Line | 972 DEL MAR DR
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City | LADY LAKE
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State | FL
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Zip | 32159-7705
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Country | US
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Telephone | 352-350-1933
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARIA T LUONG
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Credential | D.M.D.
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Telephone | 352-350-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN15788
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License Number State | FL
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