Provider Demographics
NPI:1740852342
Name:SOARES, LUCIANA MARA (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCIANA
Middle Name:MARA
Last Name:SOARES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 COLLEGE VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1103
Mailing Address - Country:US
Mailing Address - Phone:747-204-8663
Mailing Address - Fax:
Practice Address - Street 1:27420 TOURNEY RD STE 230
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-5635
Practice Address - Country:US
Practice Address - Phone:661-222-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist