Provider Demographics
NPI:1568869360
Name:DEBORAH E LUIS DMD PA
Entity Type:Organization
Organization Name:DEBORAH E LUIS DMD PA
Other - Org Name:FRESH DENTAL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PA
Authorized Official - Phone:954-741-6556
Mailing Address - Street 1:7100 W. COMMERCIAL BLVD.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2147
Mailing Address - Country:US
Mailing Address - Phone:954-741-6556
Mailing Address - Fax:954-741-1715
Practice Address - Street 1:7100 W. COMMERCIAL BLVD.
Practice Address - Street 2:SUITE 108
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2147
Practice Address - Country:US
Practice Address - Phone:954-741-6556
Practice Address - Fax:954-741-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty