MEDICARE: LUXE DENTAL PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508535659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXE DENTAL PC

Provider Business Mailing Address
First Line	:	1411 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4137
Country	:	US
Telephone Number	:	718-484-1560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4137
Country	:	US
Telephone Number	:	718-484-1560
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KIMIA KOHANBASH
Credential	:	DDS
Telephone Number	:	718-484-1560

Provider Enumeration Date	:	09/12/2021
Last Update Date	:	02/26/2025

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Directions to “LUXE DENTAL PC ” Practice Location

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