Provider Demographics
NPI:1063414175
Name:CHAMORRO, LUIS ANTONIO (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:CHAMORRO
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11535 CARMEL COMMONS BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5314
Mailing Address - Country:US
Mailing Address - Phone:704-341-3636
Mailing Address - Fax:704-341-3880
Practice Address - Street 1:11535 CARMEL COMMONS BLVD
Practice Address - Street 2:STE 205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5314
Practice Address - Country:US
Practice Address - Phone:704-341-3636
Practice Address - Fax:704-341-3880
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics