Provider Demographics
NPI:1952401465
Name:GONZALES, JOEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:J
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ROGERS ST
Mailing Address - Street 2:SUITE 3-1
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5014
Mailing Address - Country:US
Mailing Address - Phone:978-283-6252
Mailing Address - Fax:978-283-1722
Practice Address - Street 1:17 ROGERS ST
Practice Address - Street 2:SUITE 3-1
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5014
Practice Address - Country:US
Practice Address - Phone:978-283-6252
Practice Address - Fax:978-283-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14634122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist