Provider Demographics
NPI:1093887473
Name:GONZALEZ, IRMA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
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:PO BOX 1235
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613
Mailing Address - Country:US
Mailing Address - Phone:787-878-2805
Mailing Address - Fax:787-878-3887
Practice Address - Street 1:OFICIANA DENTAL FAMILIAY 1254 SANTANA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-2805
Practice Address - Fax:787-878-3887
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6120160OtherHUMANA
043021OtherBCBS
206473OtherU.T.I.
42470OtherSSS
70584OtherPREFERRED MEDICAL CHOICE