Provider Demographics
NPI:1063050771
Name:LUX DENTAL
Entity type:Organization
Organization Name:LUX DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUROVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-394-8071
Mailing Address - Street 1:10 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1328
Mailing Address - Country:US
Mailing Address - Phone:585-394-8071
Mailing Address - Fax:585-394-8529
Practice Address - Street 1:10 BROOK ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1328
Practice Address - Country:US
Practice Address - Phone:585-394-8071
Practice Address - Fax:585-394-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty