Provider Demographics
NPI:1538396791
Name:BRETON, LUIS FERNANDO (DMD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FERNANDO
Last Name:BRETON
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 1:303 RACQUET CLUB RD
Mailing Address - Street 2:APT 207
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1153
Mailing Address - Country:US
Mailing Address - Phone:954-805-9796
Mailing Address - Fax:
Practice Address - Street 1:2711 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3637
Practice Address - Country:US
Practice Address - Phone:954-321-5600
Practice Address - Fax:954-349-4739
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice