Individual provider Active NPI

Luis A Gonzalez, DMD

  • General Practice Dentistry
  • Ponce, PR
National Provider Identifier
1689732950
Registry record updated Jul 8, 2007
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1627 Issued in PR
Practice address
Santa Maria Office BLDG Suite 222 Calle Ferrocuri 450
Ponce, PR 00717-1105
Phone
(787) 840-1708
NPI assigned
Dec 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1627 PR Primary

Addresses

Primary practice location

Santa Maria Office BLDG Suite 222 Calle Ferrocuri 450
Ponce, PR 00717-1105

Mailing address

Santa Maria Office BLDG Suite 222 Calle Ferrocuri 450
Ponce, PR 00717-1105
Phone (787) 840-1708

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240106000095 PR Order and Referring Only - DentistPractitioner - Dentist 2365745346

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689732950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SANTA MARIA OFFICE BLDG SUITE 222 CALLE FERROCURI 450",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007171105",
            "telephone_number": "787-840-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SANTA MARIA OFFICE BLDG SUITE 222 CALLE FERROCURI 450",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007171105",
            "telephone_number": "787-840-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "LUIS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "1627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponce, PR

Sources for this page

Verify at the official NPI Registry.