Provider Demographics
NPI:1598138190
Name:LUX AVONDALE INC.
Entity Type:Organization
Organization Name:LUX AVONDALE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-243-9610
Mailing Address - Street 1:10320 W MCDOWELL RD
Mailing Address - Street 2:BLD A SUITE 1001
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4863
Mailing Address - Country:US
Mailing Address - Phone:623-243-9610
Mailing Address - Fax:623-249-6267
Practice Address - Street 1:10320 W MCDOWELL RD
Practice Address - Street 2:BLD A SUITE 1001
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4863
Practice Address - Country:US
Practice Address - Phone:623-243-9610
Practice Address - Fax:623-249-6267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD06416261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental