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General NPI Number Information
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NPI Number | 1396134185
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Entity Type | Organization
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Legal Business Name | RENATO DE LUNA, DMD
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 11700 NE 95TH ST SUITE 120
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City | VANCOUVER
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State | WA
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Zip | 98682-2399
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Country | US
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Telephone | 360-735-0222
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Fax | 360-735-0223
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Provider Business Mailing Address
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Address Line | 11700 NE 95TH ST SUITE 120
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City | VANCOUVER
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State | WA
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Zip | 98682-2399
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Country | US
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Telephone | 360-735-0222
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Fax | 360-735-0223
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Authorized Official
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Title or Position | MANAGER
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Name | RACHEL GORMAN
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Credential |
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Telephone | 360-735-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60244473
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License Number State | WA
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