Provider Demographics
NPI:1003119058
Name:LDV ENDODONTICS
Entity Type:Organization
Organization Name:LDV ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:VISBAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-431-1158
Mailing Address - Street 1:PO BOX 250586
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0586
Mailing Address - Country:US
Mailing Address - Phone:787-431-1158
Mailing Address - Fax:787-880-4542
Practice Address - Street 1:65 AVE BARBOSA
Practice Address - Street 2:ARECIBO MEDICAL PLAZA STE. 206
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2799
Practice Address - Country:US
Practice Address - Phone:787-817-8030
Practice Address - Fax:787-880-4542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty