Provider Demographics
NPI:1407069529
Name:ZAMBRANO, LUIS ALBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:ZAMBRANO
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 1:2012 COURTYARD LOOP
Mailing Address - Street 2:APT 106
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7446
Mailing Address - Country:US
Mailing Address - Phone:407-227-7182
Mailing Address - Fax:
Practice Address - Street 1:445 STATE ROAD 13
Practice Address - Street 2:SUITE 22
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3838
Practice Address - Country:US
Practice Address - Phone:904-209-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN144011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice