Provider Demographics
NPI:1962624577
Name:LUNA, EDGAR ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ALAN
Last Name:LUNA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5336 STADIUM TRACE PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244
Mailing Address - Country:US
Mailing Address - Phone:205-988-9700
Mailing Address - Fax:205-988-4191
Practice Address - Street 1:5336 STADIUM TRACE PARKWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1095
Practice Address - Country:US
Practice Address - Phone:205-988-9700
Practice Address - Fax:205-988-4191
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice