Provider Demographics
NPI:1326260894
Name:GONZALEZ, ANA DESIREE
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:DESIREE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29505 SW 197 AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030
Mailing Address - Country:US
Mailing Address - Phone:954-684-6162
Mailing Address - Fax:
Practice Address - Street 1:7801 SW 24TH ST
Practice Address - Street 2:SUITE 122
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6538
Practice Address - Country:US
Practice Address - Phone:786-360-3694
Practice Address - Fax:786-431-1522
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN178681223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223E0200XDental ProvidersDentistEndodontics