Provider Demographics
NPI:1114277357
Name:LUIS, DEBORAH ERIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ERIN
Last Name:LUIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2147
Mailing Address - Country:US
Mailing Address - Phone:954-741-6556
Mailing Address - Fax:954-741-1715
Practice Address - Street 1:7100 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2147
Practice Address - Country:US
Practice Address - Phone:954-741-6556
Practice Address - Fax:954-741-1715
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist