Provider Demographics
NPI:1225748692
Name:LUX DENTAL LLC
Entity Type:Organization
Organization Name:LUX DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-2871
Mailing Address - Street 1:2002 S ROUSE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6629
Mailing Address - Country:US
Mailing Address - Phone:620-231-2871
Mailing Address - Fax:
Practice Address - Street 1:204 STATE ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2031
Practice Address - Country:US
Practice Address - Phone:620-223-0130
Practice Address - Fax:620-223-1276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUX DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty