Provider Demographics
NPI:1770179830
Name:GONZALEZ, YISEL (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:YISEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11907 HICKORYNUT DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5653
Mailing Address - Country:US
Mailing Address - Phone:813-455-6335
Mailing Address - Fax:
Practice Address - Street 1:7340 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2222
Practice Address - Country:US
Practice Address - Phone:813-886-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH27839124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist