Provider Demographics
NPI:1699341156
Name:LUMIERE COSMETIC AND IMPLANT DENTISTRY
Entity type:Organization
Organization Name:LUMIERE COSMETIC AND IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-865-0987
Mailing Address - Street 1:1588 SLASH PINE PL
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8467
Mailing Address - Country:US
Mailing Address - Phone:407-865-0987
Mailing Address - Fax:
Practice Address - Street 1:400 N ORLANDO AVE STE 115
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4704
Practice Address - Country:US
Practice Address - Phone:407-680-0790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M&M FAMILY AND COSMETIC DENTISTRY PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-03
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental