Provider Demographics
NPI:1245571736
Name:HANSEL GONZALEZ PA
Entity Type:Organization
Organization Name:HANSEL GONZALEZ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HANSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-276-5938
Mailing Address - Street 1:401 CORAL WAY
Mailing Address - Street 2:SUITE#109
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4930
Mailing Address - Country:US
Mailing Address - Phone:305-529-9595
Mailing Address - Fax:
Practice Address - Street 1:401 CORAL WAY
Practice Address - Street 2:SUITE#109
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4930
Practice Address - Country:US
Practice Address - Phone:305-529-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN198521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty