Provider Demographics
NPI:1407036601
Name:GONZALEZ, RAUL C
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:C
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAUL
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1760 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2729
Mailing Address - Country:US
Mailing Address - Phone:305-551-4344
Mailing Address - Fax:305-856-8586
Practice Address - Street 1:1760 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2729
Practice Address - Country:US
Practice Address - Phone:305-551-4344
Practice Address - Fax:305-856-8586
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist