Individual
LUIS FERNANDO VALDIVIA MONTOYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
282 BIG LAKE RD APT 59, BILOXI, MS 39531-3708
(228) 239-6685
Mailing address
4001 DENNY AVE STE 1, PASCAGOULA, MS 39581-5403
(228) 471-3970
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10001-23
MS
1223G0001X
General Practice Dentistry
Primary
10001-23
MS
1223G0001X
General Practice Dentistry
7272
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/24/2019
Last updated
02/02/2025
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