Provider Demographics
NPI:1700226842
Name:PAGAN, LUIS F (DMD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:F
Last Name:PAGAN
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 1:382 NE 191 ST
Mailing Address - Street 2:'PMB 892335'
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3899
Mailing Address - Country:US
Mailing Address - Phone:503-806-0025
Mailing Address - Fax:
Practice Address - Street 1:8015 TURKEY LAKE RD STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7383
Practice Address - Country:US
Practice Address - Phone:407-205-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10214122300000X, 1223P0300X
WADE606773671223P0300X
390200000X
FLDN2925251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program