Provider Demographics
NPI:1689876476
Name:JOSE R. GONZALES. D.D.S. P.C.
Entity Type:Organization
Organization Name:JOSE R. GONZALES. D.D.S. P.C.
Other - Org Name:G DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RIVAS
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-547-0403
Mailing Address - Street 1:3060 N LITCHFIELD ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338
Mailing Address - Country:US
Mailing Address - Phone:623-547-0403
Mailing Address - Fax:623-935-0944
Practice Address - Street 1:3060 N. LITCHFIELD ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338
Practice Address - Country:US
Practice Address - Phone:623-547-0403
Practice Address - Fax:623-935-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD46781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty