Provider Demographics
NPI:1023490588
Name:GONZALES, ZACHARY NATHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:NATHAN
Last Name:GONZALES
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 1:6632 W 10TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9733
Mailing Address - Country:US
Mailing Address - Phone:970-353-4848
Mailing Address - Fax:970-356-5752
Practice Address - Street 1:6632 W 10TH ST
Practice Address - Street 2:STE 101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9733
Practice Address - Country:US
Practice Address - Phone:970-353-4848
Practice Address - Fax:970-356-5752
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021610122300000X
CO00202832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist