Provider Demographics
NPI:1447819396
Name:GONZALEZ JUNCO, LUIS ENRIQUE (DMD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ENRIQUE
Last Name:GONZALEZ JUNCO
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 1:8854 W FLAGLER ST APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2497
Mailing Address - Country:US
Mailing Address - Phone:786-370-7989
Mailing Address - Fax:
Practice Address - Street 1:5190 NW 167TH ST STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6329
Practice Address - Country:US
Practice Address - Phone:786-507-3458
Practice Address - Fax:954-953-1417
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist