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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