Provider Demographics
NPI:1518178052
Name:JACK LUFTMAN BSC DDS PC
Entity Type:Organization
Organization Name:JACK LUFTMAN BSC DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:LUFTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-993-6080
Mailing Address - Street 1:13540 W CAMINO DEL SOL
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4434
Mailing Address - Country:US
Mailing Address - Phone:623-842-0042
Mailing Address - Fax:623-842-0713
Practice Address - Street 1:13540 W CAMINO DEL SOL
Practice Address - Street 2:SUITE 6
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4434
Practice Address - Country:US
Practice Address - Phone:623-842-0042
Practice Address - Fax:623-842-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty