Provider Demographics
NPI:1346799962
Name:LUMINOUS DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:LUMINOUS DENTAL ASSOCIATES PLLC
Other - Org Name:LUMINOUS DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINHO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:469-731-5700
Mailing Address - Street 1:10710 ELDORADO PARKWAY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:469-731-5700
Mailing Address - Fax:469-731-5705
Practice Address - Street 1:10710 ELDORADO PARKWAY
Practice Address - Street 2:SUITE 160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:469-731-5700
Practice Address - Fax:469-731-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29659261QD0000X
TX28125261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental