Provider Demographics
NPI:1760868087
Name:ALBISU, PEDRO MANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:MANUEL
Last Name:ALBISU
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 1:8020 DANCING WIND LN
Mailing Address - Street 2:APT 105
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9660
Mailing Address - Country:US
Mailing Address - Phone:754-246-7112
Mailing Address - Fax:239-573-4867
Practice Address - Street 1:8020 DANCING WIND LN
Practice Address - Street 2:APT 105
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9660
Practice Address - Country:US
Practice Address - Phone:754-246-7112
Practice Address - Fax:239-573-4867
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 21529OtherDENTAL LICENSE