Provider Demographics
NPI:1609083542
Name:OSCAR GONZALEZ DDS PA
Entity Type:Organization
Organization Name:OSCAR GONZALEZ DDS PA
Other - Org Name:FLAMINGO COMMONS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-382-9696
Mailing Address - Street 1:12565 ORANGE DR
Mailing Address - Street 2:SUITE 414
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4303
Mailing Address - Country:US
Mailing Address - Phone:954-382-9696
Mailing Address - Fax:954-382-9697
Practice Address - Street 1:12565 ORANGE DR
Practice Address - Street 2:SUITE 414
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4303
Practice Address - Country:US
Practice Address - Phone:954-382-9696
Practice Address - Fax:954-382-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty