Provider Demographics
NPI:1528262052
Name:OCHOA, LUIS HERNANDO (DDS)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:HERNANDO
Last Name:OCHOA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 TUSCANY TER
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4462
Mailing Address - Country:US
Mailing Address - Phone:954-415-2713
Mailing Address - Fax:954-721-2083
Practice Address - Street 1:601 NW 179TH AVE
Practice Address - Street 2:# 101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2819
Practice Address - Country:US
Practice Address - Phone:954-415-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 179261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice