Provider Demographics
NPI:1659426203
Name:CALVO, LUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:CALVO
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:MSC 909
Mailing Address - Street 2:PO BOX 5000
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-868-3434
Mailing Address - Fax:
Practice Address - Street 1:ROAD 115 KM.24.6 CENTRO MULTISERVICIOS COOP
Practice Address - Street 2:BO. ASOMANTE
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-3434
Practice Address - Fax:787-252-0277
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice