Provider Demographics
NPI:1073705364
Name:LUMANLAN, ALDWIN PHILIP
Entity Type:Individual
Prefix:DR
First Name:ALDWIN
Middle Name:PHILIP
Last Name:LUMANLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 W 235TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4216
Mailing Address - Country:US
Mailing Address - Phone:408-307-3669
Mailing Address - Fax:
Practice Address - Street 1:946 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-2427
Practice Address - Country:US
Practice Address - Phone:310-831-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist