Provider Demographics
NPI:1790901965
Name:MASSA, LUIGI O (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIGI
Middle Name:O
Last Name:MASSA
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 1:153 FALLING HILLS DR.
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-660-1669
Mailing Address - Fax:830-401-0230
Practice Address - Street 1:104 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-3748
Practice Address - Country:US
Practice Address - Phone:830-660-1669
Practice Address - Fax:830-401-0230
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice