Provider Demographics
NPI:1740321231
Name:SARMIENTO, LUIS S (DMD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:S
Last Name:SARMIENTO
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 1:440 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1724
Mailing Address - Country:US
Mailing Address - Phone:207-775-6348
Mailing Address - Fax:207-775-6311
Practice Address - Street 1:440 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1724
Practice Address - Country:US
Practice Address - Phone:207-775-6348
Practice Address - Fax:207-775-6311
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME35261223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics