Provider Demographics
NPI:1467629956
Name:GONZALEZ, MARIA ODALIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ODALIS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10651 N KENDALL DR STE 215
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1545
Mailing Address - Country:US
Mailing Address - Phone:305-596-6069
Mailing Address - Fax:305-596-0856
Practice Address - Street 1:10651 N KENDALL DR STE 215
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1545
Practice Address - Country:US
Practice Address - Phone:305-596-6069
Practice Address - Fax:305-596-0856
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15661122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice