Provider Demographics
NPI:1396964789
Name:GONZALEZ, AGUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:
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 1:3934 SW 8TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2949
Mailing Address - Country:US
Mailing Address - Phone:786-552-9918
Mailing Address - Fax:786-552-9920
Practice Address - Street 1:3934 SW 8TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2949
Practice Address - Country:US
Practice Address - Phone:786-552-9918
Practice Address - Fax:786-552-9920
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist