Provider Demographics
NPI:1598080921
Name:VISBAL, LUZ D (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:D
Last Name:VISBAL
Suffix:
Gender:F
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:PO BOX 250586
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0586
Mailing Address - Country:US
Mailing Address - Phone:787-431-1158
Mailing Address - Fax:
Practice Address - Street 1:27605 CASHFORD CIR STE 101
Practice Address - Street 2:ENDODONTIC PROFESSIONALS
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6953
Practice Address - Country:US
Practice Address - Phone:813-907-8751
Practice Address - Fax:813-907-8763
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN215641223E0200X
PR28291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics