Provider Demographics
NPI:1114137833
Name:LUMINAIS, KEITH JAMES JR
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JAMES
Last Name:LUMINAIS
Suffix:JR
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 1:320 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3857
Mailing Address - Country:US
Mailing Address - Phone:985-735-7653
Mailing Address - Fax:985-735-7688
Practice Address - Street 1:320 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3857
Practice Address - Country:US
Practice Address - Phone:985-735-7653
Practice Address - Fax:985-735-7688
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice