Provider Demographics
NPI:1689732950
Name:GONZALEZ, LUIS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:GONZALEZ
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:SANTA MARIA OFFICE BLDG SUITE 222 CALLE FERROCURI 450
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1105
Mailing Address - Country:US
Mailing Address - Phone:787-840-1708
Mailing Address - Fax:
Practice Address - Street 1:SANTA MARIA OFFICE BLDG SUITE 222 CALLE FERROCURI 450
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1105
Practice Address - Country:US
Practice Address - Phone:787-840-1708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice