Provider Demographics
NPI:1700122850
Name:EVELYN LUMA DDS PLLC
Entity Type:Organization
Organization Name:EVELYN LUMA DDS PLLC
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-430-2600
Mailing Address - Street 1:1244 PERIMETER PKWY
Mailing Address - Street 2:SUITE 444
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5699
Mailing Address - Country:US
Mailing Address - Phone:757-430-2600
Mailing Address - Fax:757-721-5577
Practice Address - Street 1:1244 PERIMETER PKWY
Practice Address - Street 2:SUITE 444
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5699
Practice Address - Country:US
Practice Address - Phone:757-430-2600
Practice Address - Fax:757-721-5577
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178657Medicaid
VA9178657Medicaid