Provider Demographics
NPI:1902438682
Name:LUMY DENTAL INC.
Entity Type:Organization
Organization Name:LUMY DENTAL INC.
Other - Org Name:DENTALOGIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HOMAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:SAADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:331-233-1001
Mailing Address - Street 1:219 S ALDER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5342
Mailing Address - Country:US
Mailing Address - Phone:248-410-3341
Mailing Address - Fax:
Practice Address - Street 1:4425 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-7222
Practice Address - Country:US
Practice Address - Phone:331-233-1001
Practice Address - Fax:331-233-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty