Healthcare Provider Details

I. General information

NPI: 1780896738
Provider Name (Legal Business Name): JOEL FABRIGAS GONZALES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 MONTAGUE EXPY SUITE #103
MILPITAS CA
95035-6809
US

IV. Provider business mailing address

991 MONTAGUE EXPY SUITE #103
MILPITAS CA
95035-6809
US

V. Phone/Fax

Practice location:
  • Phone: 408-719-8300
  • Fax: 408-719-8399
Mailing address:
  • Phone: 408-719-8300
  • Fax: 408-719-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: