Provider Demographics
NPI:1689608762
Name:CASALS, LUIS (DDS)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:CASALS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 WEST NORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1318
Mailing Address - Country:US
Mailing Address - Phone:773-342-2969
Mailing Address - Fax:
Practice Address - Street 1:1948 W NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1318
Practice Address - Country:US
Practice Address - Phone:773-342-2969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice