Provider Demographics
NPI:1336432921
Name:PIRES, LUIS FERNANDO SOARES (DMD, MSD, MSD)
Entity type:Individual
Prefix:DR
First Name:LUIS FERNANDO
Middle Name:SOARES
Last Name:PIRES
Suffix:
Gender:M
Credentials:DMD, MSD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3650
Mailing Address - Country:US
Mailing Address - Phone:330-836-9341
Mailing Address - Fax:
Practice Address - Street 1:33 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3650
Practice Address - Country:US
Practice Address - Phone:330-836-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0234011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics