Provider Demographics
NPI:1003034497
Name:GONZALEZ DENTAL CORPORATION
Entity Type:Organization
Organization Name:GONZALEZ DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-249-3213
Mailing Address - Street 1:3901 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020
Mailing Address - Country:US
Mailing Address - Phone:818-249-3213
Mailing Address - Fax:818-249-5212
Practice Address - Street 1:3901 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020
Practice Address - Country:US
Practice Address - Phone:818-249-3213
Practice Address - Fax:818-249-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty