Provider Demographics
NPI:1083248652
Name:LUNA DENTAL PLLC
Entity type:Organization
Organization Name:LUNA DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERDLAPPOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-277-7805
Mailing Address - Street 1:4642 SANDERS MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-7089
Mailing Address - Country:US
Mailing Address - Phone:832-277-7805
Mailing Address - Fax:
Practice Address - Street 1:5822 SIENNA PKWY STE 850
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7356
Practice Address - Country:US
Practice Address - Phone:832-277-7805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-23
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty