Healthcare Provider Details

I. General information

NPI: 1033327028
Provider Name (Legal Business Name): LUIS F MOTA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 NE 163RD ST
NORTH MIAMI BEACH FL
33160-4462
US

IV. Provider business mailing address

3031 NE 163RD ST
NORTH MIAMI BEACH FL
33160-4462
US

V. Phone/Fax

Practice location:
  • Phone: 305-945-0909
  • Fax: 305-945-0907
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN15847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: