Provider Demographics
NPI:1508190943
Name:GONZALEZ, DANNELLY B (DMD)
Entity Type:Individual
Prefix:
First Name:DANNELLY
Middle Name:B
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 1:500 AVE DEGETAU STE 313
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7304
Mailing Address - Country:US
Mailing Address - Phone:787-653-6210
Mailing Address - Fax:787-653-5846
Practice Address - Street 1:500 AVE DEGETAU STE 313
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7304
Practice Address - Country:US
Practice Address - Phone:787-653-6210
Practice Address - Fax:787-653-5846
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2837122300000X, 1223E0200X
NY054436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist