Provider Demographics
NPI:1568987022
Name:GONZALEZ, SAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAUL
Middle Name:
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 1:132 WESTON RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3036
Mailing Address - Country:US
Mailing Address - Phone:919-279-0713
Mailing Address - Fax:
Practice Address - Street 1:80 AUTUMN FERN TRL
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5155
Practice Address - Country:US
Practice Address - Phone:910-814-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10825122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist