Provider Demographics
NPI:1669695565
Name:GONZALEZ, LAURA (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N HIATUS RD STE 109
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5213
Mailing Address - Country:US
Mailing Address - Phone:954-431-8484
Mailing Address - Fax:954-431-8435
Practice Address - Street 1:500 N HIATUS RD STE 109
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5213
Practice Address - Country:US
Practice Address - Phone:954-431-8484
Practice Address - Fax:954-431-8435
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice