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General NPI Number Information
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NPI Number | 1104921972
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Entity Type | Individual
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Provider Name | LUIS A. ESPINET D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 2500 W LAKE MARY BLVD #106
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City | LAKE MARY
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State | FL
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Zip | 32746-3501
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Country | US
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Telephone | 407-328-6411
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Fax | 407-328-6444
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Provider Business Mailing Address
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Address Line | 2500 W.LAKE MARY BIVD. #106
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City | LAKE MARY
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State | FL
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Zip | 32746
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Country | US
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Telephone | 407-328-6411
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Fax | 407-328-6444
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN14288
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN14288
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2240
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License Number State | PR
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