Provider Demographics
NPI:1497814503
Name:HIDALGO-GONZALEZ, ALLISON M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:M
Last Name:HIDALGO-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 1:8585 SW 72 ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-270-0171
Mailing Address - Fax:305-270-0175
Practice Address - Street 1:8585 SW 72 ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-270-0171
Practice Address - Fax:305-270-0175
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16743122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076503100Medicaid