Healthcare Provider Details

I. General information

NPI: 1174781538
Provider Name (Legal Business Name): LUIS F MOTA DMD MS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2008
Last Update Date: 06/01/2008
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:
Mailing address:
  • Phone: 305-945-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LUIS F MOTA
Title or Position: PRESIDENT
Credential: DMD
Phone: 305-945-0909