Provider Demographics
NPI:1851042311
Name:JHEZANUEL GONCALVES, D.M.D, P.A.
Entity Type:Organization
Organization Name:JHEZANUEL GONCALVES, D.M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JHEZANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONCALVES CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-669-1091
Mailing Address - Street 1:2863 EXECUTIVE PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3647
Mailing Address - Country:US
Mailing Address - Phone:954-660-1091
Mailing Address - Fax:954-669-1084
Practice Address - Street 1:2863 EXECUTIVE PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3647
Practice Address - Country:US
Practice Address - Phone:787-531-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-15
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty