Provider Demographics
NPI:1366258907
Name:LUIS FABELO, DDS, PA
Entity type:Organization
Organization Name:LUIS FABELO, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FABELO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-821-6388
Mailing Address - Street 1:6848 NW 169TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4210
Mailing Address - Country:US
Mailing Address - Phone:305-821-6388
Mailing Address - Fax:305-821-6429
Practice Address - Street 1:6848 NW 169TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4210
Practice Address - Country:US
Practice Address - Phone:305-821-6388
Practice Address - Fax:305-821-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental