Healthcare Provider Details

I. General information

NPI: 1821167388
Provider Name (Legal Business Name): FRANK F GONZALEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 W PARKSIDE LN SUITE 201
PHOENIX AZ
85027-1228
US

IV. Provider business mailing address

1852 N MASTICK WAY SUITE 4
NOGALES AZ
85621-1063
US

V. Phone/Fax

Practice location:
  • Phone: 623-434-9343
  • Fax: 623-321-6268
Mailing address:
  • Phone: 520-761-2133
  • Fax: 520-281-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5109
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier491241
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: