Provider Demographics
NPI:1659652121
Name:RUTH CHRISTINE GONZALEZ DDS PC
Entity Type:Organization
Organization Name:RUTH CHRISTINE GONZALEZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-365-9105
Mailing Address - Street 1:1815 FIRST AVE S.E.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5474
Mailing Address - Country:US
Mailing Address - Phone:319-365-9105
Mailing Address - Fax:319-866-9662
Practice Address - Street 1:3534 LAFAYETTE ROAD
Practice Address - Street 2:
Practice Address - City:EVANSDALE
Practice Address - State:IA
Practice Address - Zip Code:50707-1025
Practice Address - Country:US
Practice Address - Phone:319-233-9903
Practice Address - Fax:319-292-1696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTH CHRISTINE GONZALEZ DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1474544Medicare PIN