Provider Demographics
NPI:1871792093
Name:MYRA C LUNA DDS INC
Entity type:Organization
Organization Name:MYRA C LUNA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:CANTALEJO
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-774-7055
Mailing Address - Street 1:50 S ANAHEIM BLVD
Mailing Address - Street 2:STE 86
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2931
Mailing Address - Country:US
Mailing Address - Phone:714-774-7055
Mailing Address - Fax:714-774-0255
Practice Address - Street 1:50 S ANAHEIM BLVD STE 86
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2907
Practice Address - Country:US
Practice Address - Phone:714-774-7055
Practice Address - Fax:714-774-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty