Provider Demographics
NPI:1891108817
Name:GONZALEZ, JOSHUA DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DANIEL
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4047 ROSEWOOD DR
Mailing Address - Street 2:NONE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3562
Mailing Address - Country:US
Mailing Address - Phone:803-360-6835
Mailing Address - Fax:
Practice Address - Street 1:4323 HILL ST
Practice Address - Street 2:NONE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-3562
Practice Address - Country:US
Practice Address - Phone:803-360-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8384 GD122300000X
SCDGD.83841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist