Provider Demographics
NPI:1225383128
Name:LUERA, JACQUELYN (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:
Last Name:LUERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 PELLICANO DR STE A4
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6054
Mailing Address - Country:US
Mailing Address - Phone:915-594-4048
Mailing Address - Fax:915-594-9854
Practice Address - Street 1:11601 PELLICANO DR STE A4
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6054
Practice Address - Country:US
Practice Address - Phone:915-594-4048
Practice Address - Fax:915-594-9854
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28112122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist