Provider Demographics
NPI:1598040057
Name:TREVINO, LUIS MIGUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:MIGUEL
Last Name:TREVINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:MIGUEL
Other - Last Name:TREVINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ORTHODONTIST
Mailing Address - Street 1:110 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-4150
Mailing Address - Country:US
Mailing Address - Phone:956-237-2858
Mailing Address - Fax:
Practice Address - Street 1:JESUS CARRANZA AND WASHINGTON 2107
Practice Address - Street 2:PROFESSIONAL DENTAL SOLUTIONS
Practice Address - City:NUEVO
Practice Address - State:LAREDO
Practice Address - Zip Code:888240
Practice Address - Country:MX
Practice Address - Phone:956-267-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33953261223X0400X, 1223X0400X
ZZ33953261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty