Provider Demographics
NPI:1932254463
Name:GONZALEZ, LILIANA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILIANA
Middle Name:C
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 1:9818 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6141
Mailing Address - Country:US
Mailing Address - Phone:954-432-4800
Mailing Address - Fax:954-432-8328
Practice Address - Street 1:9818 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6141
Practice Address - Country:US
Practice Address - Phone:954-432-4800
Practice Address - Fax:954-432-8328
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist