Provider Demographics
NPI:1063644961
Name:ELEANOR M LUMAHAN DDS INC
Entity Type:Organization
Organization Name:ELEANOR M LUMAHAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:MADRID
Authorized Official - Last Name:LUMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-336-6063
Mailing Address - Street 1:1127 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3517
Mailing Address - Country:US
Mailing Address - Phone:619-336-6063
Mailing Address - Fax:619-336-6066
Practice Address - Street 1:1127 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3517
Practice Address - Country:US
Practice Address - Phone:619-336-6063
Practice Address - Fax:619-336-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD54283OtherDENTICAL
CA1518105089OtherNPPES