Provider Demographics
NPI:1922120542
Name:GONZALEZ-RUBIO, EDUARDO (DMD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:GONZALEZ-RUBIO
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 1:646 W PALM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-3210
Mailing Address - Country:US
Mailing Address - Phone:305-242-1200
Mailing Address - Fax:305-242-8782
Practice Address - Street 1:646 W PALM DR STE 200
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-3210
Practice Address - Country:US
Practice Address - Phone:305-242-1200
Practice Address - Fax:305-242-8782
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0014741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist