Provider Demographics
NPI:1235628538
Name:MEDINA TORRES, LUIS ENRIQUE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ENRIQUE
Last Name:MEDINA TORRES
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:ENRIQUE
Other - Last Name:MEDINA-TORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:8121 E INDIAN BEND RD STE 128
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4820
Mailing Address - Country:US
Mailing Address - Phone:602-482-7000
Mailing Address - Fax:
Practice Address - Street 1:4141 N 32ND ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-4775
Practice Address - Country:US
Practice Address - Phone:602-404-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD0117031223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program