Provider Demographics
NPI:1922606870
Name:RETANA, LUCIANO (DDS MS)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:
Last Name:RETANA
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 SOUTHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2679
Mailing Address - Country:US
Mailing Address - Phone:504-638-5896
Mailing Address - Fax:
Practice Address - Street 1:1235 KINWEST PKWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3403
Practice Address - Country:US
Practice Address - Phone:972-258-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367311223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics