Provider Demographics
NPI:1497287536
Name:GONZALEZ FUENTES, TANIA DENISSE (DMD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:DENISSE
Last Name:GONZALEZ FUENTES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CALLE YAGRUMO
Mailing Address - Street 2:VILLA LUCIA
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-3557
Mailing Address - Country:US
Mailing Address - Phone:787-262-5600
Mailing Address - Fax:
Practice Address - Street 1:STREET 2 KM 81.4
Practice Address - Street 2:POPULAR MORTGAGE PLAZA SUITE 203
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-262-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32851223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program