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General NPI Number Information
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NPI Number | 1174781538
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Entity Type | Organization
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Legal Business Name | LUIS F MOTA DMD MS PA
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Dates
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Enumeration Date | 06/01/2008
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Last Update Date | 06/01/2008
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Provider Practice Location Address
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Address Line | 3031 NE 163RD ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-4462
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Country | US
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Telephone | 305-945-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 3031 NE 163RD ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33160-4462
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Country | US
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Telephone | 305-945-0909
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS F MOTA
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Credential | DMD
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Telephone | 305-945-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN15847
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License Number State | FL
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