Provider Demographics
NPI:1821066812
Name:GONZALEZ, MANUEL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
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 1:601 CALLE LODI
Mailing Address - Street 2:VILLA CAPRI
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3844
Mailing Address - Country:US
Mailing Address - Phone:787-755-7802
Mailing Address - Fax:787-755-8618
Practice Address - Street 1:601 CALLE LODI
Practice Address - Street 2:VILLA CAPRI
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3844
Practice Address - Country:US
Practice Address - Phone:787-755-7802
Practice Address - Fax:787-755-8618
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry