Provider Demographics
NPI:1750427530
Name:LUMANG, GRACIA TALAG (DMD)
Entity type:Individual
Prefix:DR
First Name:GRACIA
Middle Name:TALAG
Last Name:LUMANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10972 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2120
Mailing Address - Country:US
Mailing Address - Phone:858-578-6071
Mailing Address - Fax:
Practice Address - Street 1:10737 CAMINO RUIZ
Practice Address - Street 2:SUITE 145
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:858-578-8171
Practice Address - Fax:858-578-0133
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist