Provider Demographics
NPI:1932231982
Name:GONZALEZ, ENRIQUE A (DMD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12-15 CALLE SEGOVIA
Mailing Address - Street 2:TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3102
Mailing Address - Country:US
Mailing Address - Phone:787-781-0732
Mailing Address - Fax:787-793-6938
Practice Address - Street 1:39 CALLE DR VEVE
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6301
Practice Address - Country:US
Practice Address - Phone:787-780-3830
Practice Address - Fax:787-793-6938
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist