Provider Demographics
NPI:1063645455
Name:GONZALEZ, ELMER ELEAZAR (PHD, RDH)
Entity type:Individual
Prefix:
First Name:ELMER
Middle Name:ELEAZAR
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHD, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 S ESPINA ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-1290
Mailing Address - Country:US
Mailing Address - Phone:575-528-7071
Mailing Address - Fax:
Practice Address - Street 1:3400 S ESPINA ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-1290
Practice Address - Country:US
Practice Address - Phone:575-528-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH3025124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist