Provider Demographics
NPI:1184763450
Name:ARTISTIC CENTER FOR DENTISTRY, INC.
Entity type:Organization
Organization Name:ARTISTIC CENTER FOR DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:DIEM
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-760-0366
Mailing Address - Street 1:5820 S WILLIAMSON BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6400
Mailing Address - Country:US
Mailing Address - Phone:386-760-0366
Mailing Address - Fax:
Practice Address - Street 1:5820 S WILLIAMSON BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6400
Practice Address - Country:US
Practice Address - Phone:386-760-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty