Provider Demographics
NPI:1497917363
Name:GONZALEZ LAY, HECTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:
Last Name:GONZALEZ LAY
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 1:23871 US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-7811
Mailing Address - Country:US
Mailing Address - Phone:863-678-3177
Mailing Address - Fax:863-678-3188
Practice Address - Street 1:23871 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-7811
Practice Address - Country:US
Practice Address - Phone:863-678-3177
Practice Address - Fax:863-678-3188
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN125011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice