Healthcare Provider Details

I. General information

NPI: 1912965930
Provider Name (Legal Business Name): LUIS EDUARDO CARDENAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SW 129TH AVE SUITE 400
PEMBROKE PINES FL
33027-1761
US

IV. Provider business mailing address

5531 N UNIVERSITY DR SUITE 104
CORAL SPRINGS FL
33067-4649
US

V. Phone/Fax

Practice location:
  • Phone: 954-432-2080
  • Fax: 954-432-5560
Mailing address:
  • Phone: 954-227-4892
  • Fax: 954-227-4894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN13740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: