MEDICARE: LUMIERE COSMETIC AND IMPLANT DENTISTRY

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1699341156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMIERE COSMETIC AND IMPLANT DENTISTRY

Provider Business Mailing Address
First Line	:	1588 SLASH PINE PL
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-8467
Country	:	US
Telephone Number	:	407-865-0987
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N ORLANDO AVE STE 115
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-4704
Country	:	US
Telephone Number	:	407-680-0790
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEHRSHAD YOUSEFI
Credential	:	DMD
Telephone Number	:	407-865-0987

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	04/15/2024

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