Provider Demographics
NPI:1457908733
Name:LUNA, JOSE (RDH)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18420 JADE LN
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5181
Mailing Address - Country:US
Mailing Address - Phone:408-889-3112
Mailing Address - Fax:
Practice Address - Street 1:3571 N 1ST ST STE 203
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-1803
Practice Address - Country:US
Practice Address - Phone:310-409-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33008124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist