Provider Demographics
NPI:1558480798
Name:GONZALEZ, LUIS E (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ZMS #245 RIO HONDO MALL
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-780-4199
Mailing Address - Fax:787-740-4095
Practice Address - Street 1:TILO ST. EA #34
Practice Address - Street 2:LOS ALMENDROS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-4199
Practice Address - Fax:787-740-4095
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics