Healthcare Provider Details

I. General information

NPI: 1487611109
Provider Name (Legal Business Name): LUIS GONZALEZ-MORALES D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 AVE SAN LUIS
ARECIBO PR
00612-3640
US

IV. Provider business mailing address

PO BOX 1903
ARECIBO PR
00613-1903
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-0901
  • Fax:
Mailing address:
  • Phone: 787-878-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2196
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: