Provider Demographics
NPI:1487611836
Name:GONZALEZ-ESTRADA, VICTOR MANUEL JR (DDS)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MANUEL
Last Name:GONZALEZ-ESTRADA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:DE DIEGO AVE
Mailing Address - Street 2:#150 SUITE 709
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-724-0660
Mailing Address - Fax:787-724-0660
Practice Address - Street 1:DE DIEGO AVE
Practice Address - Street 2:#150 SUITE 709
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-724-0660
Practice Address - Fax:787-724-0660
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist