Healthcare Provider Details

I. General information

NPI: 1033372644
Provider Name (Legal Business Name): LUIS C YEPES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR 2.563U
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

14111 VANCE JACKSON RD APT 14208
SAN ANTONIO TX
78249-1972
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5562
  • Fax:
Mailing address:
  • Phone: 859-489-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28352
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: