MEDICARE: DR. JAIME GONZALEZ DDS

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
1	1223G0001X	General Practice Dentistry	55982	CA

General Provider Information

NPI Number	:	1629249412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME GONZALEZ DDS

Provider Business Mailing Address
First Line	:	1516 MAIN ST STE 106A
Second Line	:
City	:	RAMONA
State	:	CA
Zip	:	92065-5242
Country	:	US
Telephone Number	:	780-787-0962
Fax Number	:	760-787-0851

Provider Business Practice Location Address
First Line	:	1516 MAIN ST STE 106A
Second Line	:
City	:	RAMONA
State	:	CA
Zip	:	92065-5242
Country	:	US
Telephone Number	:	780-787-0962
Fax Number	:	760-787-0851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	06/05/2008

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