Provider Demographics
NPI:1093878043
Name:GONZALEZ, REINOL ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:REINOL
Middle Name:ANTONIO
Last Name:GONZALEZ
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 1:4789 SW 148TH AVE
Mailing Address - Street 2:SUITE #205
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2119
Mailing Address - Country:US
Mailing Address - Phone:954-252-5911
Mailing Address - Fax:954-434-8075
Practice Address - Street 1:4789 SW 148TH AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-2119
Practice Address - Country:US
Practice Address - Phone:954-252-5911
Practice Address - Fax:954-434-8075
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist