Provider Demographics
NPI:1225385370
Name:GONZALEZ, REYDEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:REYDEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11870 HIALEAH GARDENS BLVD
Mailing Address - Street 2:SUITE 129 A
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4235
Mailing Address - Country:US
Mailing Address - Phone:786-536-7537
Mailing Address - Fax:786-534-5934
Practice Address - Street 1:11870 HIALEAH GARDENS BLVD
Practice Address - Street 2:SUITE 129 A
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4235
Practice Address - Country:US
Practice Address - Phone:786-536-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 199231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice