Provider Demographics
NPI:1801588090
Name:YANES GONZALEZ, CARLOS (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:YANES GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E WOOLBRIGHT RD # 331
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6192
Mailing Address - Country:US
Mailing Address - Phone:786-333-6681
Mailing Address - Fax:
Practice Address - Street 1:2900 N MILITARY TRL STE 105
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6347
Practice Address - Country:US
Practice Address - Phone:561-999-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist