Provider Demographics
NPI:1366594186
Name:LEBRON, SANTOS LUIS (DMD)
Entity type:Individual
Prefix:DR
First Name:SANTOS
Middle Name:LUIS
Last Name:LEBRON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D2 CALLE 3
Mailing Address - Street 2:MANSIONES DE GUAYNABO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5224
Mailing Address - Country:US
Mailing Address - Phone:787-790-1940
Mailing Address - Fax:
Practice Address - Street 1:D2 CALLE 3
Practice Address - Street 2:MANSIONES DE GUAYNABO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5224
Practice Address - Country:US
Practice Address - Phone:787-790-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD012961223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics