Provider Demographics
NPI:1417018508
Name:GONZALEZ, OSCAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12565 ORANGE DRIVE
Mailing Address - Street 2:SUITE 414
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330
Mailing Address - Country:US
Mailing Address - Phone:954-382-9696
Mailing Address - Fax:954-382-9697
Practice Address - Street 1:12565 ORANGE DR
Practice Address - Street 2:SUITE 414
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4303
Practice Address - Country:US
Practice Address - Phone:954-382-9696
Practice Address - Fax:954-382-9697
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN150861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice