Healthcare Provider Details

I. General information

NPI: 1396712261
Provider Name (Legal Business Name): LUIS FRANCISCO GONZALEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 AVE MUNOZ MARIN QUADRANGLE MEDICAL CENTER SUITE 309
CAGUAS PR
00725-3975
US

IV. Provider business mailing address

PO BOX 1195
CAGUAS PR
00726-1195
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-0363
  • Fax: 787-743-0383
Mailing address:
  • Phone: 787-746-0363
  • Fax: 787-743-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number00757
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: