Provider Demographics
NPI:1659562478
Name:MARINI, LUIS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:MARINI
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:CALLE CESAR GONZALEZ # 612
Mailing Address - Street 2:APT. 1602
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3901
Mailing Address - Country:US
Mailing Address - Phone:787-553-9303
Mailing Address - Fax:
Practice Address - Street 1:654 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 1111
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4123
Practice Address - Country:US
Practice Address - Phone:787-553-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry