Provider Demographics
NPI:1104921972
Name:ESPINET, LUIS A (DMD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:ESPINET
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 1:2500 W.LAKE MARY BIVD.
Mailing Address - Street 2:#106
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746
Mailing Address - Country:US
Mailing Address - Phone:407-328-6411
Mailing Address - Fax:407-328-6444
Practice Address - Street 1:2500 W LAKE MARY BLVD
Practice Address - Street 2:#106
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3501
Practice Address - Country:US
Practice Address - Phone:407-328-6411
Practice Address - Fax:407-328-6444
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14288122300000X, 1223G0001X
PR22401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics