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NPI Code Detail

MEDICARE: RAYMOND GONZALEZ DMD

MEDICARE: RAYMOND GONZALEZ DMD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2122300000XDentistDN27060FL

General Provider Information

NPI Number : 1447980677
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYMOND GONZALEZ DMD
Provider Business Mailing Address
First Line : 205 MONICA ST
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33954-1220
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1750 TAMIAMI TRL STE 100
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33948-1045
Country : US
Telephone Number : 941-235-1001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2022
Last Update Date : 06/20/2022

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Directions to “ RAYMOND GONZALEZ DMD” Practice Location

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