Provider Demographics
NPI:1346458718
Name:LEMOS, LUIS FERNANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FERNANDO
Last Name:LEMOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10875 SINCLARE CIR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6549
Mailing Address - Country:US
Mailing Address - Phone:909-435-9616
Mailing Address - Fax:
Practice Address - Street 1:1825 UNIVERSITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5345
Practice Address - Country:US
Practice Address - Phone:951-781-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice