Provider Demographics
NPI:1811378359
Name:GONZALEZ, YANELA (DMD)
Entity Type:Individual
Prefix:
First Name:YANELA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6085 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3037
Mailing Address - Country:US
Mailing Address - Phone:754-222-4874
Mailing Address - Fax:754-222-4862
Practice Address - Street 1:6085 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3037
Practice Address - Country:US
Practice Address - Phone:754-222-4874
Practice Address - Fax:754-222-4862
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN212471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice