Provider Demographics
NPI:1164974176
Name:ORRACA, LUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:ORRACA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BETONY LOOP
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-4407
Mailing Address - Country:US
Mailing Address - Phone:512-593-8999
Mailing Address - Fax:512-593-7949
Practice Address - Street 1:11330 MENCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-2879
Practice Address - Country:US
Practice Address - Phone:787-608-9864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3234122300000X
TX336101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist