Provider Demographics
NPI:1871851535
Name:OFICINA DENTAL DR. LUIS C. GAUD FLORES Y ASOCIADOS CSP
Entity Type:Organization
Organization Name:OFICINA DENTAL DR. LUIS C. GAUD FLORES Y ASOCIADOS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-866-5227
Mailing Address - Street 1:LA FUENTE TOWNCENTER
Mailing Address - Street 2:706 CALLE MARGINAL SUITE 11122
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-866-5227
Mailing Address - Fax:
Practice Address - Street 1:PEDRO ALBIZU CAMPOS AV
Practice Address - Street 2: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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2371261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental