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General NPI Number Information
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NPI Number | 1740006899
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Entity Type | Individual
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Provider Name | LUIS CARLOS MUNGUIA DENTIST
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Gender | Male
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 502 AVENIDA KINO 5 Y 6
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City | SAN LUIS
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State | SONORA
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Zip | 83449
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Country | MX
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Telephone | 653-534-5515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 624
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City | SAN LUIS
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State | AZ
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Zip | 85349-0624
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Country | US
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Telephone | 653-534-1515
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Fax |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 1751642
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1751642
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License Number State | ZZ
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1751642
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 1751642
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License Number State | ZZ
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Taxonomy #5
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 1751642
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License Number State | ZZ
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 1751642
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License Number State | ZZ
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Taxonomy #7
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 1751642
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License Number State | AZ
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Taxonomy #8
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | 1751642
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License Number State | ZZ
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Taxonomy #9
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1751642
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License Number State | ZZ
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Taxonomy #10
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number | 1751642
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License Number State | AZ
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Taxonomy #11
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 1751642
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License Number State | ZZ
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