Provider Demographics
NPI:1558537589
Name:GONZALEZ, CHRISTIAN GUILLERMO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:GUILLERMO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 MARCOS DR
Mailing Address - Street 2:APT. S611
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2583
Mailing Address - Country:US
Mailing Address - Phone:786-337-2852
Mailing Address - Fax:
Practice Address - Street 1:3020 MARCOS DR APT S611
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160
Practice Address - Country:US
Practice Address - Phone:786-337-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110924363A00000X
NY0595861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant