=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336276203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUMINITA MARKHAM DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 05/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 MAIDU DR #100
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95603-5808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-823-8771
-----------------------------------------------------
Fax | 530-823-8194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 MAIDU DR #100
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95603-5808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-823-8771
-----------------------------------------------------
Fax | 530-823-8194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 46743
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------