Provider Demographics
NPI:1407247489
Name:LB DENTAL INC.
Entity Type:Organization
Organization Name:LB DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDALO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-482-5100
Mailing Address - Street 1:4045 E BELL RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2236
Mailing Address - Country:US
Mailing Address - Phone:602-482-5100
Mailing Address - Fax:602-482-5105
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-482-5100
Practice Address - Fax:602-482-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ337216OtherAHCCCS