Provider Demographics
NPI:1669523767
Name:GONZALEZ, YANICE (DMD)
Entity type:Individual
Prefix:DR
First Name:YANICE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:YANICE
Other - Middle Name:
Other - Last Name:GOMEZ-RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6622 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4201
Mailing Address - Country:US
Mailing Address - Phone:786-281-8752
Mailing Address - Fax:561-659-1145
Practice Address - Street 1:333 SOUTHERN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2654
Practice Address - Country:US
Practice Address - Phone:561-835-0633
Practice Address - Fax:561-659-1145
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist