Provider Demographics
NPI:1265658785
Name:GONZALES, DANTE ALAN (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:DANTE
Middle Name:ALAN
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 JOAQUIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4905
Mailing Address - Country:US
Mailing Address - Phone:925-828-2244
Mailing Address - Fax:925-828-9955
Practice Address - Street 1:532 JOAQUIN AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4905
Practice Address - Country:US
Practice Address - Phone:925-828-2244
Practice Address - Fax:925-828-9955
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43163OtherSTATE LICENSE NUMBER