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General NPI Number Information
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NPI Number | 1407247489
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Entity Type | Organization
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Legal Business Name | LB DENTAL INC.
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 4045 E BELL RD SUITE 115
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City | PHOENIX
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State | AZ
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Zip | 85032-2236
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Country | US
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Telephone | 602-482-5100
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Fax | 602-482-5105
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Provider Business Mailing Address
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Address Line | 4045 E BELL RD SUITE 115
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City | PHOENIX
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State | AZ
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Zip | 85032-2236
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Country | US
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Telephone | 602-482-5100
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Fax | 602-482-5105
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUKA BUNDALO
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Credential | DDS
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Telephone | 602-482-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6073
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License Number State | AZ
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