Provider Demographics
NPI:1386475770
Name:GONZALEZ YUMAR, ROBERTO CARLOS (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:CARLOS
Last Name:GONZALEZ YUMAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:CARLOS
Other - Last Name:GONZALEZ YUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:819 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5042
Mailing Address - Country:US
Mailing Address - Phone:561-667-7931
Mailing Address - Fax:
Practice Address - Street 1:10075 S JOG RD STE 108
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3532
Practice Address - Country:US
Practice Address - Phone:561-738-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN261581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics