Provider Demographics
NPI:1235484361
Name:ALVARADO AMADO, LUIS MIGUEL (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:LUIS MIGUEL
Middle Name:
Last Name:ALVARADO AMADO
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 KAYLA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4257
Mailing Address - Country:US
Mailing Address - Phone:318-996-3949
Mailing Address - Fax:318-545-5593
Practice Address - Street 1:275 KAYLA ST STE 100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4257
Practice Address - Country:US
Practice Address - Phone:318-996-3949
Practice Address - Fax:318-545-5593
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68141223P0700X
WADE609776791223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics