Provider Demographics
NPI:1821441940
Name:GONZALEZ FERGUSON, ALEJANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRA
Middle Name:
Last Name:GONZALEZ FERGUSON
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 1:3420 BAYSIDE LAKES BLVD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6813
Mailing Address - Country:US
Mailing Address - Phone:321-722-0155
Mailing Address - Fax:321-722-1978
Practice Address - Street 1:3420 BAYSIDE LAKES BLVD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6813
Practice Address - Country:US
Practice Address - Phone:321-722-0155
Practice Address - Fax:321-722-1978
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist