Individual provider Active NPI

Luis Alberto Zambrano, DMD

  • General Practice Dentistry
  • Deltona, FL
National Provider Identifier
1407069529
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN14401 Issued in FL
Practice address
1674 Providence Blvd
Deltona, FL 32725-4961
Phone
(386) 218-3316
NPI assigned
May 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN14401 FL Primary

Addresses

Primary practice location

1674 Providence Blvd
Deltona, FL 32725-4961

Mailing address

1674 Providence Blvd
Deltona, FL 32725-4961
Phone (386) 218-3316

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
DN14401FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Breathe Sleep Dream LLC CurrentSince Sep 29, 2024 Accepting new patients
Coast Dental P.a. Past Accepting new patients
Coast Dental P.a. PastSince Jun 22, 2021 Accepting new patients

Locations

1674 Providence Blvd
Deltona, FL 32725
Phone (386) 218-3316

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1407069529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1674 PROVIDENCE BLVD",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327254961",
            "telephone_number": "386-218-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1674 PROVIDENCE BLVD",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327254961",
            "telephone_number": "386-218-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZAMBRANO",
        "first_name": "LUIS",
        "middle_name": "ALBERTO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deltona, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.