Provider Demographics
NPI:1235113705
Name:GONZALEZ-BIANCHI, CRISTOBAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:
Last Name:GONZALEZ-BIANCHI
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:P.O. BOX 140098
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0098
Mailing Address - Country:US
Mailing Address - Phone:787-879-5556
Mailing Address - Fax:787-880-6901
Practice Address - Street 1:CARR #2 KM 81.5
Practice Address - Street 2:SUITE 569
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-2801
Practice Address - Country:US
Practice Address - Phone:787-879-5556
Practice Address - Fax:787-880-6901
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD15971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice