MEDICARE: EVELYN LUMA DDS PLLC

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	122300000X	Dentist	0401410284	VA

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	:	1700122850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELYN LUMA DDS PLLC

Provider Business Mailing Address
First Line	:	1244 PERIMETER PKWY
Second Line	:	SUITE 444
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5699
Country	:	US
Telephone Number	:	757-430-2600
Fax Number	:	757-721-5577

Provider Business Practice Location Address
First Line	:	1244 PERIMETER PKWY
Second Line	:	SUITE 444
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5699
Country	:	US
Telephone Number	:	757-430-2600
Fax Number	:	757-721-5577

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. EVELYN E LUMA
Credential	:	DDS
Telephone Number	:	757-430-2600

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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