Provider Demographics
NPI:1629242342
Name:CABRERA, LUZ E (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:E
Last Name:CABRERA
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 1:224 BULLARD PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5512
Mailing Address - Country:US
Mailing Address - Phone:813-988-2729
Mailing Address - Fax:813-988-8729
Practice Address - Street 1:224 E BULLARD PKWY
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5512
Practice Address - Country:US
Practice Address - Phone:813-988-2729
Practice Address - Fax:813-988-8729
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-0014538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBC5582463OtherBLUE CROSS BLUE SHIELD
FL071698700Medicaid