Provider Demographics
NPI:1093948994
Name:GONZALEZ, JOAN MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MARIE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:BLUNDELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1044 BELCHER RD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5680
Mailing Address - Country:US
Mailing Address - Phone:727-738-8845
Mailing Address - Fax:727-738-1466
Practice Address - Street 1:1044 BELCHER RD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5680
Practice Address - Country:US
Practice Address - Phone:727-738-8845
Practice Address - Fax:727-738-1466
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN232511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice