Provider Demographics
NPI:1184169443
Name:RENEE LOUISE GONZALEZ, DDS, INC.
Entity type:Organization
Organization Name:RENEE LOUISE GONZALEZ, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-276-2145
Mailing Address - Street 1:2305 MORENA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4166
Mailing Address - Country:US
Mailing Address - Phone:619-276-2145
Mailing Address - Fax:619-276-2305
Practice Address - Street 1:2305 MORENA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4166
Practice Address - Country:US
Practice Address - Phone:619-276-2145
Practice Address - Fax:619-276-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA498901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty