Provider Demographics
NPI:1619295771
Name:MATOS, LUIS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:MATOS
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 1:175 TONEY PENNA DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5755
Mailing Address - Country:US
Mailing Address - Phone:561-745-2881
Mailing Address - Fax:
Practice Address - Street 1:175 TONEY PENNA DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5755
Practice Address - Country:US
Practice Address - Phone:561-745-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 188871223P0221X
GADN0137331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry