MEDICARE: LUIS E REAL D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	52460	CA

General Provider Information

NPI Number	:	1013905447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS E REAL D.D.S.

Provider Business Mailing Address
First Line	:	690 E ST
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-2113
Country	:	US
Telephone Number	:	619-425-2122
Fax Number	:	619-425-2125

Provider Business Practice Location Address
First Line	:	690 E ST
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-2113
Country	:	US
Telephone Number	:	619-425-2122
Fax Number	:	619-425-2125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

Similar Medicare Providers

1245681055 — REAL DENTAL CORP
Practice Location Address:

690 E ST
CHULA VISTA, CA
91910-2113

Practice Phone: 619-425-2122
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1275963266 — ALEXIS SALUTA PT
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1053378497 — HOUSTON NEUROLOGICAL INSTITUTE LLP
Practice Location Address:

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Practice Phone: 713-941-3100
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1295782738 — DR. ROBERT W. FAYLE M.D.
Practice Location Address:

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1700992641 — DR. PRITI PALVADI M.D.
Practice Location Address:

4141 VISTA RD
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77504-2113

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1154403426 — DR. DAREL A BUTLER MD
Practice Location Address:

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Practice Phone: 713-947-3100
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