Provider Demographics
NPI:1992427082
Name:CA GONZALEZ DENTAL CORP
Entity type:Organization
Organization Name:CA GONZALEZ DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CUAUHTEMOC
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-996-0384
Mailing Address - Street 1:4909 REGAL CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5025
Mailing Address - Country:US
Mailing Address - Phone:916-996-0485
Mailing Address - Fax:
Practice Address - Street 1:620 TWELVE BRIDGES DR STE 120
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8867
Practice Address - Country:US
Practice Address - Phone:916-996-0384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty