MEDICARE: MR. LUIS EDGARDO FORTUNO-MOSCOSO D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	401	PR

General Provider Information

NPI Number	:	1306119532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS EDGARDO FORTUNO-MOSCOSO D.M.D.

Provider Business Mailing Address
First Line	:	C8 CALLE LA ROGATIVA
Second Line	:	PASEO SAN JUAN
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6505
Country	:	US
Telephone Number	:	787-642-4433
Fax Number	:	787-293-4161

Provider Business Practice Location Address
First Line	:	C8 CALLE LA ROGATIVA
Second Line	:	PASEO SAN JUAN
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6505
Country	:	US
Telephone Number	:	787-642-4433
Fax Number	:	787-293-4161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2012
Last Update Date	:	04/05/2026

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