Provider Demographics
NPI:1942552385
Name:GARCIA-GONZALEZ, GLORIA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:M
Last Name:GARCIA-GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 HAMPTON DR
Mailing Address - Street 2:UNIT E
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-8641
Mailing Address - Country:US
Mailing Address - Phone:787-457-5411
Mailing Address - Fax:
Practice Address - Street 1:252 HAMPTON DR
Practice Address - Street 2:UNIT E
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-8641
Practice Address - Country:US
Practice Address - Phone:787-457-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist