Provider Demographics
NPI:1932892643
Name:LUFF DENTAL LLC
Entity Type:Organization
Organization Name:LUFF DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADDIE
Authorized Official - Middle Name:MILAM
Authorized Official - Last Name:LUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-875-3391
Mailing Address - Street 1:688 SE BAYBERRY LN STE 101
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4392
Mailing Address - Country:US
Mailing Address - Phone:816-875-3391
Mailing Address - Fax:
Practice Address - Street 1:688 SE BAYBERRY LN STE 101
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4392
Practice Address - Country:US
Practice Address - Phone:816-875-3391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental