Organization
LUMINA DENTAL SERVICES LLC
Active
Other names
Evesboro Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ROXANA LARISA MACIEJESKI DDS (DENTIST)
(702) 600-3964
Entity
Organization
Contact information
Practice address
105 MEDFORD-EVESBORO RD B, MARLTON, NJ 08053
(856) 985-0330
Mailing address
2412 CHESTNUT HILL DR, CINNAMINSON, NJ 08077-3623
(702) 600-3964
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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