Provider Demographics
NPI:1720243249
Name:BARGREN, LUZ LIM (DDS)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:LIM
Last Name:BARGREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARIALUZ
Other - Middle Name:L
Other - Last Name:TANSINSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5638 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9696
Mailing Address - Country:US
Mailing Address - Phone:269-429-4661
Mailing Address - Fax:269-429-4486
Practice Address - Street 1:5638 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9696
Practice Address - Country:US
Practice Address - Phone:269-429-4661
Practice Address - Fax:269-429-4486
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist