Provider Demographics
NPI:1144089962
Name:LUNA SMILES LLC
Entity type:Organization
Organization Name:LUNA SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DARJI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-938-7606
Mailing Address - Street 1:30 JACKSON RD STE B1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9280
Mailing Address - Country:US
Mailing Address - Phone:609-953-0077
Mailing Address - Fax:
Practice Address - Street 1:801 S CHURCH ST STE 11
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2572
Practice Address - Country:US
Practice Address - Phone:856-866-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty