Provider Demographics
NPI:1508886037
Name:FABELO, LUIS O (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:O
Last Name:FABELO
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 1:6848 NW 169TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4210
Mailing Address - Country:US
Mailing Address - Phone:305-821-6388
Mailing Address - Fax:305-821-6429
Practice Address - Street 1:6848 NW 169TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4210
Practice Address - Country:US
Practice Address - Phone:305-821-6388
Practice Address - Fax:305-821-6429
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL151441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice