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General NPI Number Information
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NPI Number | 1225177645
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Entity Type | Individual
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Provider Name | LUIS F GONZALEZ DM
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CARR 857 KM 0.4 BO CANOVANILLAS DENTALIA MEDIKA CORP
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City | CAROLINA
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State | PR
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Zip | 00987-0800
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Country | US
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Telephone | 787-363-9378
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Fax | 787-276-2923
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Provider Business Mailing Address
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Address Line | PO BOX 800
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City | CAROLINA
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State | PR
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Zip | 00986-0800
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Country | US
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Telephone | 787-363-9378
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Fax | 787-276-2923
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1272
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License Number State | PR
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