Provider Demographics
NPI:1548432263
Name:LUMA DENTAL PC
Entity Type:Organization
Organization Name:LUMA DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:FUJISHIGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-989-5253
Mailing Address - Street 1:20 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7501
Mailing Address - Country:US
Mailing Address - Phone:212-989-5253
Mailing Address - Fax:212-989-5263
Practice Address - Street 1:20 W 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7501
Practice Address - Country:US
Practice Address - Phone:212-989-5253
Practice Address - Fax:212-989-5263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK DENTAL GROUP LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-02
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0395951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1508801838Medicaid