Provider Demographics
NPI:1538316955
Name:GONZALES, SHRUTI JAYANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHRUTI
Middle Name:JAYANT
Last Name:GONZALES
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 1:10 PETTI LN
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1080
Mailing Address - Country:US
Mailing Address - Phone:908-222-1433
Mailing Address - Fax:
Practice Address - Street 1:906 OAK TREE AVE
Practice Address - Street 2:SUITE M
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5127
Practice Address - Country:US
Practice Address - Phone:908-769-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023714001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice