Provider Demographics
NPI:1689890055
Name:CONTRERAS, LUIS ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:CONTRERAS
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 1:1340 IMPERIAL BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-3046
Mailing Address - Country:US
Mailing Address - Phone:619-575-6644
Mailing Address - Fax:619-424-9457
Practice Address - Street 1:1340 IMPERIAL BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-3046
Practice Address - Country:US
Practice Address - Phone:619-575-6644
Practice Address - Fax:619-424-9457
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist