Provider Demographics
NPI:1275637969
Name:GONZALEZ, RUTH CHRISTINE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:CHRISTINE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 FIRST AVENUE S.E.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402
Mailing Address - Country:US
Mailing Address - Phone:319-365-9105
Mailing Address - Fax:319-866-9662
Practice Address - Street 1:1815 FIRST AVENUE S.E.
Practice Address - Street 2:SUITE 102
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-365-9105
Practice Address - Fax:319-866-9662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08433122300000X
IAPERMIT40085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1474544Medicare PIN