Provider Demographics
NPI:1770720344
Name:TEIXEIRA, LUIS NETO (DMD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:NETO
Last Name:TEIXEIRA
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 1:875 E CANAL DR STE 8
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4542
Mailing Address - Country:US
Mailing Address - Phone:209-632-3101
Mailing Address - Fax:209-632-2920
Practice Address - Street 1:875 E CANAL DR STE 8
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4542
Practice Address - Country:US
Practice Address - Phone:209-632-3101
Practice Address - Fax:209-632-2920
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice