Provider Demographics
NPI:1356026355
Name:GIGATO GONZALEZ, JOSE ALEJANDRO (DDS)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:GIGATO 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 1:120 HENNEPIN AVE APT 224
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2310
Mailing Address - Country:US
Mailing Address - Phone:786-973-3866
Mailing Address - Fax:
Practice Address - Street 1:12904 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55434-4147
Practice Address - Country:US
Practice Address - Phone:763-755-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND149351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty