Provider Demographics
NPI:1972668499
Name:GONZALEZ, JOSE R (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
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 1:2735 N BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1705
Mailing Address - Country:US
Mailing Address - Phone:559-225-3391
Mailing Address - Fax:559-225-1601
Practice Address - Street 1:2735 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1705
Practice Address - Country:US
Practice Address - Phone:559-225-3391
Practice Address - Fax:559-225-1601
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice