Healthcare Provider Details

I. General information

NPI: 1942457080
Provider Name (Legal Business Name): SHAWNEEN M GONZALEZ DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH & HOLDREGE ST
LINCOLN NE
68583-0740
US

IV. Provider business mailing address

7000 N 16TH ST # A
LINCOLN NE
68521-9076
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-1370
  • Fax:
Mailing address:
  • Phone: 402-805-4134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number6793
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number08450
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: