Provider Demographics
NPI:1952311813
Name:GONZALEZ, MITZI M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITZI
Middle Name:M
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 AVE WINSTON CHURCHILL
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6651
Mailing Address - Country:US
Mailing Address - Phone:787-294-1437
Mailing Address - Fax:787-294-1438
Practice Address - Street 1:200 AVE WINSTON CHURCHILL
Practice Address - Street 2:SUITE 403
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6651
Practice Address - Country:US
Practice Address - Phone:787-294-1437
Practice Address - Fax:787-294-1438
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics