Provider Demographics
NPI:1962886820
Name:LUIZ DOS SANTOS INC
Entity type:Organization
Organization Name:LUIZ DOS SANTOS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIZ
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:DOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-870-6161
Mailing Address - Street 1:1350 S JONES BLVD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1213
Mailing Address - Country:US
Mailing Address - Phone:702-870-6161
Mailing Address - Fax:702-870-2302
Practice Address - Street 1:1350 S JONES BLVD
Practice Address - Street 2:SUITE #140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1213
Practice Address - Country:US
Practice Address - Phone:702-870-6161
Practice Address - Fax:702-870-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty