Provider Demographics
NPI:1790584852
Name:DE LIMA DIAS, LUIZ CARLOS JR (DDS, MSC, PHD)
Entity type:Individual
Prefix:DR
First Name:LUIZ CARLOS
Middle Name:
Last Name:DE LIMA DIAS
Suffix:JR
Gender:
Credentials:DDS, MSC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10508 SHADOW RIDGE LN APT 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5403
Mailing Address - Country:US
Mailing Address - Phone:502-210-7070
Mailing Address - Fax:
Practice Address - Street 1:501 S PRESTON ST STE 319
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1701
Practice Address - Country:US
Practice Address - Phone:502-210-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist