Provider Demographics
NPI:1073285961
Name:PC DENTAL SPECIALTIES LUIS PIRES DMD LLC
Entity Type:Organization
Organization Name:PC DENTAL SPECIALTIES LUIS PIRES DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-836-9341
Mailing Address - Street 1:33 BAKER BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3650
Mailing Address - Country:US
Mailing Address - Phone:330-836-9341
Mailing Address - Fax:
Practice Address - Street 1:33 BAKER BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3650
Practice Address - Country:US
Practice Address - Phone:330-836-9341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty