Provider Demographics
NPI:1811686348
Name:MARC GONZALEZ, DDS, PLLC
Entity type:Organization
Organization Name:MARC GONZALEZ, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-264-6181
Mailing Address - Street 1:22415 MARKET ST APT 1229
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-3032
Mailing Address - Country:US
Mailing Address - Phone:704-264-6181
Mailing Address - Fax:
Practice Address - Street 1:745 BILTMORE AVE STE 101
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2556
Practice Address - Country:US
Practice Address - Phone:828-771-6319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental