Provider Demographics
NPI:1083248652
Name:LUNA DENTAL PLLC
Entity Type:Organization
Organization Name:LUNA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERDLAPPOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-277-7805
Mailing Address - Street 1:4410 WESTHEIMER RD APT 3218
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-1814
Mailing Address - Country:US
Mailing Address - Phone:832-277-7805
Mailing Address - Fax:
Practice Address - Street 1:5425 HIGHWAY 6 STE C100
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4390
Practice Address - Country:US
Practice Address - Phone:832-277-7805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-23
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty