Provider Demographics
NPI:1609923002
Name:GONZALEZ, YOLY MARICEL (DDS, MS)
Entity Type:Individual
Prefix:
First Name:YOLY
Middle Name:MARICEL
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 MAIN ST
Mailing Address - Street 2:355 SQUIRE HALL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-3551
Mailing Address - Fax:716-829-3554
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:355 SQUIRE HALL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-3551
Practice Address - Fax:716-829-3554
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052599-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist