Provider Demographics
NPI:1255359295
Name:DENIZARD, LUIS ENRIQUE (DMD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:DENIZARD
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 1:6108 COGNAC CIR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2854
Mailing Address - Country:US
Mailing Address - Phone:813-416-3668
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B. DOWNS BLVD.
Practice Address - Street 2:DENTAL SERVICE (160)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-0000
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:813-910-4038
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist