Provider Demographics
NPI:1912965930
Name:CARDENAS, LUIS EDUARDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDUARDO
Last Name:CARDENAS
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 1:5531 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4649
Mailing Address - Country:US
Mailing Address - Phone:954-227-4892
Mailing Address - Fax:954-227-4894
Practice Address - Street 1:1 SW 129TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1761
Practice Address - Country:US
Practice Address - Phone:954-432-2080
Practice Address - Fax:954-432-5560
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN137401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2043705OtherTAX ID
FL21328CMedicare PIN
FL59-2043705OtherTAX ID
FL21328BMedicare PIN
FL21328Medicare PIN