Provider Demographics
NPI:1740006899
Name:MUNGUIA, LUIS CARLOS (DENTIST)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:CARLOS
Last Name:MUNGUIA
Suffix:
Gender:M
Credentials:DENTIST
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 624
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349-0624
Mailing Address - Country:US
Mailing Address - Phone:653-534-1515
Mailing Address - Fax:
Practice Address - Street 1:502 AVENIDA KINO 5 Y 6
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:SONORA
Practice Address - Zip Code:83449
Practice Address - Country:MX
Practice Address - Phone:653-534-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17516421223E0200X, 1223P0221X, 1223X0008X, 1223X2210X
ZZ17516421223P0221X, 1223P0300X, 1223P0700X, 1223S0112X, 1223X0008X, 1223X0400X, 1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodontics
No1223P0221XDental ProvidersDentistPediatric Dentistry
No1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223X2210XDental ProvidersDentistOrofacial Pain