Healthcare Provider Details

I. General information

NPI: 1992909345
Provider Name (Legal Business Name): VICTOR GONZALEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N MILWAUKEE AVE
WHEELING IL
60090-3013
US

IV. Provider business mailing address

3115 N OCONTO AVE
CHICAGO IL
60707-1232
US

V. Phone/Fax

Practice location:
  • Phone: 847-353-8050
  • Fax:
Mailing address:
  • Phone: 773-501-2827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019027378
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: