Provider Demographics
NPI:1275826117
Name:GONZALEZ, ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
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 1:1951 SW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2633
Mailing Address - Country:US
Mailing Address - Phone:305-989-8707
Mailing Address - Fax:
Practice Address - Street 1:151 BISHOP MURPHY DR
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1329
Practice Address - Country:US
Practice Address - Phone:301-689-6780
Practice Address - Fax:301-687-8011
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149371223G0001X
FLDN19668122300000X
WV3947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist