Provider Demographics
NPI:1407075849
Name:GONZALES, DORIS P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:P
Last Name:GONZALES
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 1:767 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1324
Mailing Address - Country:US
Mailing Address - Phone:203-753-5041
Mailing Address - Fax:203-753-5044
Practice Address - Street 1:767 WOLCOTT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1324
Practice Address - Country:US
Practice Address - Phone:203-753-5041
Practice Address - Fax:203-753-5044
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0083971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice