1518178052 NPI number — JACK LUFTMAN BSC DDS PC

Table of content: (NPI 1518178052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518178052 NPI number — JACK LUFTMAN BSC DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACK LUFTMAN BSC DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518178052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13540 W CAMINO DEL SOL
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
SUN CITY WEST
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85375-4434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-842-0042
Provider Business Mailing Address Fax Number:
623-842-0713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13540 W CAMINO DEL SOL
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SUN CITY WEST
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85375-4434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-842-0042
Provider Business Practice Location Address Fax Number:
623-842-0713
Provider Enumeration Date:
05/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUFTMAN
Authorized Official First Name:
JACK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
602-993-6080

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)