Organization
LB DENTAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUKA BUNDALO DDS (OWNER)
(602) 482-5100
Entity
Organization
Contact information
Practice address
4045 E BELL RD, SUITE 115, PHOENIX, AZ 85032-2236
(602) 482-5100
(602) 482-5105
Mailing address
4045 E BELL RD, SUITE 115, PHOENIX, AZ 85032-2236
(602) 482-5100
(602) 482-5105
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6073
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
337216
AHCCCS
AZ
Enumeration date
02/11/2015
Last updated
02/11/2015
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