Provider Demographics
NPI:1750090270
Name:LUX DENTAL LLC
Entity type:Organization
Organization Name:LUX DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-2871
Mailing Address - Street 1:2002 S ROUSE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6629
Mailing Address - Country:US
Mailing Address - Phone:620-231-2871
Mailing Address - Fax:
Practice Address - Street 1:2002 S ROUSE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6629
Practice Address - Country:US
Practice Address - Phone:620-231-2871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUX DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-23
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental