Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1720134091 Individual Practitioner Male Practitioner

Dr. Modesto Luis , DDS

Dentist - General Practice • South Gate, CA

Professional Overview & Biography Verified Profile Summary

Dr. Modesto Luis, DDS is a registered healthcare professional specializing in Dentist - General Practice in South Gate, CA. Practice services are available at 4444 TWEEDY BLVD under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4444 Tweedy Blvd

South Gate, CA 902806304

Telephone 3235642444
Fax 3232497565
Associated Practice Facility / Clinic
🏢 Scott Jacks Dds Inc Facility NPI 1366549545

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in South Gate, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 21.7 Yrs
Regional Practice Density
31 Specialists

Practicing in South Gate, CA (18734 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License CA 36401

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
D36401 (CA)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

25 Associated Practitioners
Dr. Namie Kong , DMD

Dentist - Pediatric Dentistry

NPI 1013297795

Doctor of Dental Medicine

Dr. Sabina Wiederkehr , DDS

Dentist - General Practice

NPI 1043356728

Doctor of Dental Surgery

Dr. Andrew Widdifield , DMD

Dentist - General Practice

NPI 1164139002

Doctor of Dental Medicine

Dr. Jessica Ray , DDS

Dentist - General Practice

NPI 1184882458

Doctor of Dental Surgery

Dr. Irina Tarnavsky , DDS

Dentist - General Practice

NPI 1194861872

Doctor of Dental Surgery

Dr. Julie Lazo , DDS

Dentist - General Practice

NPI 1215083589

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 4444 TWEEDY BLVD, SOUTH GATE, CA 902806304 (Tel: 3235642444)

📍
Updated Business Mailing Address July 09, 2007

Registered at 5238 LOS CABALLEROS WAY, LOS ANGELES, CA 900271012

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as MODESTO LUIS, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Dentist (License #36401 in CA)

🟢
Initial NPI Registration & Enumeration January 26, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1720134091
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 26, 2007
Last Update: July 09, 2007
Sole Proprietor: No

Mailing Address

5238 Los Caballeros Way

Los Angeles, CA 900271012

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.