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Organization
LUMINA DENTAL OF LUTZ, PA
Active
Organization
LUMINA DENTAL OF LUTZ, PA
Active
Other names
LUMINA DENTAL OF LUTZ
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D IVEY DMD (OWNER)
(813) 381-5858
Entity
Organization
Contact information
Practice address
2425 BRUNELLO TRCE, LUTZ, FL 33558-7800
(813) 381-5858
Mailing address
2945 GUINEVERE DR, TITUSVILLE, FL 32780-5916
(321) 431-2208
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/18/2019
Last updated
12/18/2019
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