Provider Demographics
NPI:1184603177
Name:LAMOUTTE, ANDRE R (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:R
Last Name:LAMOUTTE
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:URB LUAREA CALLE LODI A 3
Mailing Address - Street 2:VILLA CAPRI NORTE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-764-2424
Mailing Address - Fax:787-296-2424
Practice Address - Street 1:URB LUAREA CALLE LODI A 3
Practice Address - Street 2:VILLA CAPRI NORTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-764-2424
Practice Address - Fax:787-296-2424
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist