Provider Demographics
NPI:1629126214
Name:KAREN H. GONZALEZ, D.D.S. LLC
Entity Type:Organization
Organization Name:KAREN H. GONZALEZ, D.D.S. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOULDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-348-1245
Mailing Address - Street 1:4000 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE 128B
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3104
Mailing Address - Country:US
Mailing Address - Phone:301-464-4672
Mailing Address - Fax:301-464-2864
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 128B
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:301-464-4672
Practice Address - Fax:301-464-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD82701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty