Provider Demographics
NPI:1629166087
Name:LUNA, CARLO (DDS)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14509 CARLOS ST
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5133
Mailing Address - Country:US
Mailing Address - Phone:210-589-0585
Mailing Address - Fax:
Practice Address - Street 1:4220 BELDEN VILLAGE ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2536
Practice Address - Country:US
Practice Address - Phone:234-203-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224081223G0001X
OH219731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice