Provider Demographics
NPI:1437871985
Name:GONZALEZ, ANDRES MIGUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:MIGUEL
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 1:353 KING ST APT 536
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-1681
Mailing Address - Country:US
Mailing Address - Phone:408-799-9816
Mailing Address - Fax:
Practice Address - Street 1:48 VICENTE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1336
Practice Address - Country:US
Practice Address - Phone:415-681-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1078011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice