Provider Demographics
NPI:1578835500
Name:GONZALEZ, OCTAVIO ALBERTO (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:ALBERTO
Last Name:GONZALEZ
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Gender:M
Credentials:DDS, PHD
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Mailing Address - Street 1:1095 VA HEALTH SCIENCES RESEARCH BUILDING
Mailing Address - Street 2:ROOM 414
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0305
Mailing Address - Country:US
Mailing Address - Phone:859-323-0125
Mailing Address - Fax:859-257-6566
Practice Address - Street 1:800 ROSE STREET
Practice Address - Street 2:ROOM D104
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0297
Practice Address - Country:US
Practice Address - Phone:859-323-1345
Practice Address - Fax:859-257-5859
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
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Provider Licenses
StateLicense IDTaxonomies
KY91391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice