Provider Demographics
NPI:1225177645
Name:GONZALEZ, LUIS F (DM)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:F
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0800
Mailing Address - Country:US
Mailing Address - Phone:787-363-9378
Mailing Address - Fax:787-276-2923
Practice Address - Street 1:CARR 857 KM 0.4 BO CANOVANILLAS
Practice Address - Street 2:DENTALIA MEDIKA CORP
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-0800
Practice Address - Country:US
Practice Address - Phone:787-363-9378
Practice Address - Fax:787-276-2923
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1272OtherDENTIST LICENCES