Provider Demographics
NPI:1881181501
Name:OSPINA, LUZ AIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:AIDA
Last Name:OSPINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 SE 10TH AVE APT 7117
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3187
Mailing Address - Country:US
Mailing Address - Phone:208-312-0190
Mailing Address - Fax:
Practice Address - Street 1:1507 S HIAWASSEE RD STE 209
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5719
Practice Address - Country:US
Practice Address - Phone:407-286-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist