Provider Demographics
NPI:1740328483
Name:GONZALEZ, MARY ANN NMN (DDS)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:NMN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8475 UVA DR
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-6224
Mailing Address - Country:US
Mailing Address - Phone:707-485-5514
Mailing Address - Fax:
Practice Address - Street 1:6991 N STATE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9629
Practice Address - Country:US
Practice Address - Phone:707-485-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA316141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice