Provider Demographics
NPI:1306273495
Name:GONZALEZ, ELIAS DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:DANIEL
Last Name:GONZALEZ
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 1:6028 FOREST GREEN RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-1850
Mailing Address - Country:US
Mailing Address - Phone:850-748-4892
Mailing Address - Fax:
Practice Address - Street 1:760 EAST AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-5136
Practice Address - Country:US
Practice Address - Phone:850-452-8970
Practice Address - Fax:850-452-8978
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24806122300000X
TX28919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist