Healthcare Provider Details

I. General information

NPI: 1639037823
Provider Name (Legal Business Name): DARIO GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13794 BEACH BLVD STE 1
JACKSONVILLE FL
32224-1228
US

IV. Provider business mailing address

13794 BEACH BLVD STE 1
JACKSONVILLE FL
32224-1228
US

V. Phone/Fax

Practice location:
  • Phone: 904-207-7756
  • Fax:
Mailing address:
  • Phone: 904-207-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: