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General NPI Number Information
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NPI Number | 1679496814
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Entity Type | Organization
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Legal Business Name | LUMINA DENTAL PLLC
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 1101 5TH ST STE 101
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City | CORALVILLE
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State | IA
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Zip | 52241-2904
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Country | US
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Telephone | 319-337-9996
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 9TH STREET PL
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City | CORALVILLE
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State | IA
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Zip | 52241-1402
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Country | US
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Telephone | 815-520-6776
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | MIRANDA FOSTER
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Credential | DDS
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Telephone | 815-520-6776
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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 |
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License Number State |
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