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General NPI Number Information
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NPI Number | 1992933725
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Entity Type | Individual
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Provider Name | RENATO DE LUNA DMD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 1 BOSTON MEDICAL CENTER PLACE BOSTON MEDICAL CENTER
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City | BOSTON
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State | MA
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Zip | 02118
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Country | US
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Telephone | 714-803-9121
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Fax |
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Provider Business Mailing Address
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Address Line | 160 PLEASANT ST APT 907
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City | MALDEN
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State | MA
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Zip | 02148-4832
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Country | US
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Telephone | 714-803-9121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA
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License Number State | MA
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Taxonomy #2
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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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