Provider Demographics
NPI:1578902813
Name:GONZALEZ, KENIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENIA
Middle Name:
Last Name:GONZALEZ
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 1:6526 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2140
Mailing Address - Country:US
Mailing Address - Phone:954-983-0644
Mailing Address - Fax:954-966-7482
Practice Address - Street 1:6526 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2140
Practice Address - Country:US
Practice Address - Phone:954-983-0644
Practice Address - Fax:954-966-7482
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist