Healthcare Provider Details

I. General information

NPI: 1740531672
Provider Name (Legal Business Name): JOSE RICARDO GONZALEZ, D.D.S. A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 W MANNING AVE
REEDLEY CA
93654
US

IV. Provider business mailing address

2735 N BLACKSTONE AVE
FRESNO CA
93703-1705
US

V. Phone/Fax

Practice location:
  • Phone: 559-637-0123
  • Fax: 559-225-1601
Mailing address:
  • Phone: 559-225-3391
  • Fax: 559-225-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number47263
License Number StateCA

VIII. Authorized Official

Name: DR. JOSE R GONZALEZ
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 559-225-3391