MEDICARE: DR. LUIS GONZALEZ-MORALES D.M.D., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2196	PR

General Provider Information

NPI Number	:	1487611109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS GONZALEZ-MORALES D.M.D., M.S.

Provider Business Mailing Address
First Line	:	PO BOX 1903
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00613-1903
Country	:	US
Telephone Number	:	787-878-0901
Fax Number	:

Provider Business Practice Location Address
First Line	:	556 AVE SAN LUIS
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-3640
Country	:	US
Telephone Number	:	787-878-0901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/16/2014

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