Healthcare Provider Details

I. General information

NPI: 1205764537
Provider Name (Legal Business Name): SUNRISE DENTAL & WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 W NORTH BLVD
LEESBURG FL
34748-3900
US

IV. Provider business mailing address

1495 RIVIERA DR
KISSIMMEE FL
34744-6647
US

V. Phone/Fax

Practice location:
  • Phone: 352-626-5060
  • Fax: 352-626-5099
Mailing address:
  • Phone: 352-626-5060
  • Fax: 352-626-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS CARMELO GAUD
Title or Position: DENTIST OWNER
Credential: DMD
Phone: 407-401-3542