Provider Demographics
NPI:1821167388
Name:GONZALEZ, FRANK F (DMD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:F
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1852 N MASTICK WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1063
Mailing Address - Country:US
Mailing Address - Phone:520-761-2133
Mailing Address - Fax:520-281-2335
Practice Address - Street 1:1904 W PARKSIDE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1228
Practice Address - Country:US
Practice Address - Phone:623-434-9343
Practice Address - Fax:623-321-6268
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-01-14
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Provider Licenses
StateLicense IDTaxonomies
AZ51091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ491241Medicaid