Provider Demographics
NPI:1790883155
Name:GONZALEZ, EDUARDO GENTRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:GENTRY
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 VALLEYDALE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2714
Mailing Address - Country:US
Mailing Address - Phone:205-991-7797
Mailing Address - Fax:205-995-9994
Practice Address - Street 1:2633 VALLEYDALE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-2714
Practice Address - Country:US
Practice Address - Phone:205-991-7797
Practice Address - Fax:205-995-9994
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL31965OtherBLUE CROSS BLUE SHIELD