Provider Demographics
NPI:1093116717
Name:DELUNA DENTAL CORPORATION
Entity Type:Organization
Organization Name:DELUNA DENTAL CORPORATION
Other - Org Name:MURRIETA DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE EMMANUEL
Authorized Official - Middle Name:RUBIO
Authorized Official - Last Name:DE LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-696-2515
Mailing Address - Street 1:40165 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:SUITE # M
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6434
Mailing Address - Country:US
Mailing Address - Phone:951-696-2515
Mailing Address - Fax:951-696-2155
Practice Address - Street 1:40165 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:SUITE # M
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-6434
Practice Address - Country:US
Practice Address - Phone:951-696-2515
Practice Address - Fax:951-696-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013180777OtherMEDICAL