Provider Demographics
NPI:1851569735
Name:GONZALEZ, ROLANDO O (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:O
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 E 1ST ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5303
Mailing Address - Country:US
Mailing Address - Phone:714-541-6333
Mailing Address - Fax:714-541-0680
Practice Address - Street 1:431 E 1ST ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5303
Practice Address - Country:US
Practice Address - Phone:714-541-6333
Practice Address - Fax:714-541-0680
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3320201Medicaid