Provider Demographics
NPI:1164621488
Name:GONZALEZ-FABIAN, ODY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ODY
Middle Name:
Last Name:GONZALEZ-FABIAN
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 1:9757 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2381
Mailing Address - Country:US
Mailing Address - Phone:305-477-5299
Mailing Address - Fax:305-477-5219
Practice Address - Street 1:9757 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2381
Practice Address - Country:US
Practice Address - Phone:305-477-5299
Practice Address - Fax:305-477-5219
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL161731223X0400X
MA203951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics