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NPI Code Detail

MEDICARE: DR. GEORGE ANDREW GONZALEZ D.M.D.

MEDICARE: DR. GEORGE ANDREW GONZALEZ D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0700XProsthodontics39801CA

General Provider Information

NPI Number : 1114906484
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GEORGE ANDREW GONZALEZ D.M.D.
Provider Business Mailing Address
First Line : 70 SILVER BEACH DR
Second Line :
City : STEILACOOM
State : WA
Zip : 98388-1520
Country : US
Telephone Number : 253-584-9525
Fax Number :
Provider Business Practice Location Address
First Line : 9600 VETERANS DR SW
Second Line : AMERICAN LAKE VAMC (A-112-DENT)
City : TACOMA
State : WA
Zip : 98493-0003
Country : US
Telephone Number : 253-589-4005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 07/08/2007

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