Provider Demographics
NPI:1164624326
Name:GONZALEZ, RICARDO C (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:C
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 1:2600 S DOUGLAS RD
Mailing Address - Street 2:910
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6127
Mailing Address - Country:US
Mailing Address - Phone:305-445-1144
Mailing Address - Fax:
Practice Address - Street 1:2600 S DOUGLAS RD
Practice Address - Street 2:910
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6127
Practice Address - Country:US
Practice Address - Phone:305-445-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN01180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist