Provider Demographics
NPI:1386845725
Name:GAUD, LUIS CARMELO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:CARMELO
Last Name:GAUD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LA FUENTE TOWNCENTER 706 MARGINAL
Mailing Address - Street 2:SUITE 11122
Mailing Address - City:GUAYAMA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00784
Mailing Address - Country:UM
Mailing Address - Phone:787-866-5227
Mailing Address - Fax:
Practice Address - Street 1:LA FUENTE TOWNCENTER
Practice Address - Street 2:706 MARGINAL SUITE 11122
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-866-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23711223G0001X
FL172311223G0001X
MD386131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice