Provider Demographics
NPI:1275945875
Name:LUNA, JORDAN CORNELIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:CORNELIO
Last Name:LUNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 S COLLINS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4634
Mailing Address - Country:US
Mailing Address - Phone:972-226-6655
Mailing Address - Fax:
Practice Address - Street 1:192 S COLLINS RD STE 100
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-4634
Practice Address - Country:US
Practice Address - Phone:972-226-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist