Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1427 | PR |
N | 1223P0221X | Pediatric Dentist | 16666 | MA |
NPI | 1023144136 |
---|---|
Provider Name | Dr. Jeannette Luna |
First Address | Guaynabo, PR 00966-3166 |
Second Address | Bayamon, PR 00959-5108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2007 |
Last Update Date | 08/07/2007 |