Individual provider Active NPI

Luis Antonio Gonzalez, D.M.D, M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Birmingham, AL
National Provider Identifier
1982673513
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
14669 Issued in AL
Practice address
101 Heatherbrooke Park Dr
Birmingham, AL 35242-8008
Phone
(205) 991-9787
Fax
(205) 991-2687
NPI assigned
Mar 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 14669 AL Primary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 3935 AL

Addresses

Primary practice location

101 Heatherbrooke Park Dr
Birmingham, AL 35242-8008

Mailing address

4029 Greystone Dr
Birmingham, AL 35242-6406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170620001667 AL Order and Referring Only - Maxillofacial SurgeryPractitioner - Maxillofacial Surgery 7618245499

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
3935ALMDProfessional Counselor
14669ALMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Maniscalco Oral and Facial Surgery LLC PastSince Aug 14, 2022 Accepting new patients
Gonzalez & Carr, P.C. Oral and Maxillofacial Surgery Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1982673513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4029 GREYSTONE DR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352426406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 HEATHERBROOKE PARK DR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352428008",
            "telephone_number": "205-991-9787",
            "fax_number": "205-991-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "LUIS",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "D.M.D, M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "14669",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "3935",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.