NPIMap

Individual provider Active NPI

Luis Fernando Valdivia Montoya, DDS

  • General Practice Dentistry
  • Biloxi, MS
National Provider Identifier
1235783622
Registry record updated Feb 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10001-23 Issued in MS
Practice address
282 Big Lake Rd Apt 59
Biloxi, MS 39531-3708
Phone
(228) 239-6685
NPI assigned
Jul 24, 2019
Last updated
Feb 2, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 10001-23 MS
General Practice Dentistry 1223G0001X 7272 LA
General Practice Dentistry 1223G0001X 10001-23 MS Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

282 Big Lake Rd Apt 59
Biloxi, MS 39531-3708

Mailing address

4001 Denny Ave Ste 1
Pascagoula, MS 39581-5403
Phone (228) 471-3970

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
10001-23MSMDDentist
7272LAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Luis Valdivia DDS, PLLC General Practice CurrentSince Feb 9, 2025 Accepting new patients
Park Dental Group - Pascagoula PLLC General Practice CurrentSince Feb 9, 2025 Accepting new patients

Locations

4001 Denny Ave
Ste 1
Pascagoula, MS 39581
Phone (228) 363-1047

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738454400000",
    "number": "1235783622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 DENNY AVE STE 1",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815403",
            "telephone_number": "228-471-3970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "282 BIG LAKE RD APT 59",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395313708",
            "telephone_number": "228-239-6685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALDIVIA MONTOYA",
        "first_name": "LUIS",
        "middle_name": "FERNANDO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-24",
        "last_updated": "2025-02-02",
        "certification_date": "2025-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "10001-23",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "7272",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "10001-23",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.