Provider Demographics
NPI:1457593840
Name:GONZALEZ, YANEY (DMD)
Entity type:Individual
Prefix:DR
First Name:YANEY
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 W FLAGLER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3440
Mailing Address - Country:US
Mailing Address - Phone:786-281-8177
Mailing Address - Fax:
Practice Address - Street 1:7030 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6206
Practice Address - Country:US
Practice Address - Phone:904-786-5850
Practice Address - Fax:904-786-3101
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist