MEDICARE: LUMEN ORAL HOLDINGS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1346190584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMEN ORAL HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	501 W MULBERRY ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-1137
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 W MULBERRY ST
Second Line	:
City	:	BARABOO
State	:	WI
Zip	:	53913-1137
Country	:	US
Telephone Number	:	608-356-3838
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	SHAINA ZHAO
Credential	:
Telephone Number	:	608-356-3838

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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