Provider Demographics
NPI:1851454920
Name:HENDRICK GONZALEZ DDS INC
Entity Type:Organization
Organization Name:HENDRICK GONZALEZ DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-922-7725
Mailing Address - Street 1:125 W STOWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458
Mailing Address - Country:US
Mailing Address - Phone:805-922-7725
Mailing Address - Fax:805-922-7726
Practice Address - Street 1:125 W STOWELL RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458
Practice Address - Country:US
Practice Address - Phone:805-922-7725
Practice Address - Fax:805-922-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS06041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty