Provider Demographics
NPI:1023284015
Name:FELIPE, LUIS FELIPE (DDS)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FELIPE
Last Name:FELIPE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4360
Mailing Address - Country:US
Mailing Address - Phone:305-556-3512
Mailing Address - Fax:305-887-3491
Practice Address - Street 1:3333 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4360
Practice Address - Country:US
Practice Address - Phone:305-556-3512
Practice Address - Fax:305-887-3491
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 10742122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice