| Lumina Dental Studio | |
|
14364 Brookhurst St Garden Grove CA 92843-4608 | |
| (714) 531-1088 | |
| Not Available |
| Full Name | Lumina Dental Studio |
|---|---|
| Speciality | Dentist |
| Location | 14364 Brookhurst St, Garden Grove, California |
| Authorized Official Name and Position | Emmy Le Nur (OWNER) |
| Authorized Official Contact | 7144048547 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lumina Dental Studio 14364 Brookhurst St Garden Grove CA 92843-4608 Ph: (714) 531-1088 | Lumina Dental Studio 14364 Brookhurst St Garden Grove CA 92843-4608 Ph: (714) 531-1088 |
| NPI Number | 1922659721 |
|---|---|
| Provider Enumeration Date | 09/23/2019 |
| Last Update Date | 11/04/2022 |
| Medicare PECOS PAC ID | 5799182390 |
|---|---|
| Medicare Enrollment ID | O20210924000511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922659721 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Emmy Le Nur |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1518113158 PECOS PAC ID: 8628388063 Enrollment ID: I20210924000714 |
| Provider Name | Bich Ngoc Le |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1447455431 PECOS PAC ID: 8628374477 Enrollment ID: I20210928001281 |
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