Healthcare Provider Details

I. General information

NPI: 1205079878
Provider Name (Legal Business Name): GLORIMAR LLAVONA GONZALEZ D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18503 PINES BLVD STE 305
PEMBROKE PINES FL
33029-1406
US

IV. Provider business mailing address

2575 GLADES CIR STE 3
WESTON FL
33327-2254
US

V. Phone/Fax

Practice location:
  • Phone: 954-349-4993
  • Fax:
Mailing address:
  • Phone: 305-542-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17469
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: