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Organization
LUMINA DENTAL OF LAKELAND,PA
Active
Organization
LUMINA DENTAL OF LAKELAND,PA
Active
Other names
LUMINA DENTAL OF LAKELAND
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN IVEY DMD (OWNER)
(321) 431-2208
Entity
Organization
Contact information
Practice address
4912 SOUTHFORK DR, LAKELAND, FL 33813-2042
(863) 455-4348
Mailing address
4912 SOUTHFORK DR, LAKELAND, FL 33813-2042
(863) 455-4348
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/20/2019
Last updated
12/20/2019
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