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General NPI Number Information
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NPI Number | 1861909723
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Entity Type | Individual
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Provider Name | LUISA F CARVAJAL DDS
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Gender | Female
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Dates
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Enumeration Date | 01/01/2018
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Last Update Date | 01/01/2018
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Provider Practice Location Address
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Address Line | 516 MARY ESTHER CTO NW STE 2
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4025
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Country | US
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Telephone | 850-659-3119
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 N URSULA ST UNIT 329
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City | AURORA
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State | CO
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Zip | 80045-7411
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Country | US
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Telephone | 786-715-8423
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN23137
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License Number State | FL
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