Provider Demographics
NPI:1558844233
Name:BEVERLY P. GONZALES DDS INC
Entity Type:Organization
Organization Name:BEVERLY P. GONZALES DDS INC
Other - Org Name:BEVERLY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARICELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-865-0999
Mailing Address - Street 1:5031 LA PALMA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1623
Mailing Address - Country:US
Mailing Address - Phone:562-865-0999
Mailing Address - Fax:
Practice Address - Street 1:5031 LA PALMA AVE STE B
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1623
Practice Address - Country:US
Practice Address - Phone:562-865-0999
Practice Address - Fax:562-865-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty