Provider Demographics
NPI:1750117115
Name:RG PROSTHODONTICS
Entity type:Organization
Organization Name:RG PROSTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-PANECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-728-5014
Mailing Address - Street 1:30643 FM 2978 RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30643 FM 2978 RD BLDG B
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2316
Practice Address - Country:US
Practice Address - Phone:786-728-5014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental