Provider Demographics
NPI:1598793911
Name:RENTA, LUIS G (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:G
Last Name:RENTA
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 1:57 CALLE ANGEL C MORALES E
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2403
Mailing Address - Country:US
Mailing Address - Phone:787-737-5956
Mailing Address - Fax:787-737-5956
Practice Address - Street 1:57 CALLE ANGEL C MORALES E
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2403
Practice Address - Country:US
Practice Address - Phone:787-737-5956
Practice Address - Fax:787-737-5956
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice