Provider Demographics
NPI:1073691382
Name:GONZALEZ, HECTOR VIZZERA (DDS)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:VIZZERA
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1208
Mailing Address - Country:US
Mailing Address - Phone:602-258-1255
Mailing Address - Fax:623-294-6626
Practice Address - Street 1:380 E VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1208
Practice Address - Country:US
Practice Address - Phone:602-258-1255
Practice Address - Fax:623-294-6626
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist