# LUM KIDS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TMJ AMD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720777840
- **Authorized official:** NICOLE ROUSCULP (DIRECTOR OF BUSINESS OPERATIONS)
- **Authorized official phone:** (574) 968-5166

## Contact information

- **Practice address:** 7221 N FIR RD, GRANGER, IN 46530
- **Practice address phone:** (574) 968-5166
- **Practice address fax:** (877) 317-3186
- **Mailing address:** 7221 FIR RD, GRANGER, IN 46530-0078
- **Mailing address phone:** (574) 968-5166
- **Mailing address fax:** (877) 317-3186

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/04/2023
- **Last updated:** 09/16/2026