Provider Demographics
NPI:1023466992
Name:BARBOSA, LUIZ ALEXANDRE (DDS , MS)
Entity type:Individual
Prefix:DR
First Name:LUIZ
Middle Name:ALEXANDRE
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:DDS , MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N FEDERAL HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5181
Mailing Address - Country:US
Mailing Address - Phone:561-440-3355
Mailing Address - Fax:
Practice Address - Street 1:4400 N FEDERAL HWY STE 130
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5181
Practice Address - Country:US
Practice Address - Phone:561-440-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN200561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics