Provider Demographics
NPI:1639122997
Name:GONZALEZ, RICARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 N FARNSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-1576
Mailing Address - Country:US
Mailing Address - Phone:630-898-3610
Mailing Address - Fax:630-898-6362
Practice Address - Street 1:1780 N FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-1576
Practice Address - Country:US
Practice Address - Phone:630-898-3610
Practice Address - Fax:630-898-6362
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0184571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry