Healthcare Provider Details

I. General information

NPI: 1487950648
Provider Name (Legal Business Name): VICTOR GONZALEZ DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
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

145 N MILWAUKEE AVE
WHEELING IL
60090-3013
US

V. Phone/Fax

Practice location:
  • Phone: 847-353-8050
  • Fax:
Mailing address:
  • Phone: 847-353-8067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019027378
License Number StateIL

VIII. Authorized Official

Name: DR. VICTOR GONZALEZ
Title or Position: DENTIST
Credential: DDS
Phone: 773-501-2827