MEDICARE: LUIS F PAGAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D10214	OR
2	1223P0300X	Periodontics	DE60677367	WA
3	1223P0300X	Periodontics	D10214	OR
4	390200000X	Student in an Organized Health Care Education/Training Program
5	1223P0300X	Periodontics	DN292525	FL

General Provider Information

NPI Number	:	1700226842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS F PAGAN D.M.D.

Provider Business Mailing Address
First Line	:	382 NE 191 ST
Second Line	:	'PMB 892335'
City	:	MIAMI
State	:	FL
Zip	:	33179-3899
Country	:	US
Telephone Number	:	503-806-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	8015 TURKEY LAKE RD STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7383
Country	:	US
Telephone Number	:	407-205-0246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	10/09/2024

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