Provider Demographics
NPI:1841217619
Name:ALLISON HIDALGO-GONZALEZ, DMD, PL
Entity Type:Organization
Organization Name:ALLISON HIDALGO-GONZALEZ, DMD, PL
Other - Org Name:SUNSET SMILES DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HIDALGO-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-270-0171
Mailing Address - Street 1:8585 SW 72 ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-270-0171
Mailing Address - Fax:305-270-0175
Practice Address - Street 1:8585 SW 72 ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-270-0171
Practice Address - Fax:305-270-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076503100Medicaid