Provider Demographics
NPI:1457415275
Name:CORREA-LUNA, ADOLFO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:
Last Name:CORREA-LUNA
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:PO BOX 364074
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4074
Mailing Address - Country:US
Mailing Address - Phone:787-781-7030
Mailing Address - Fax:787-783-6235
Practice Address - Street 1:1165 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-5604
Practice Address - Country:US
Practice Address - Phone:787-781-7030
Practice Address - Fax:787-783-6235
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry