Healthcare Provider Details

I. General information

NPI: 1992892244
Provider Name (Legal Business Name): JOSE GILBERTO GONZALEZ-GONZALEZ D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUMMIT BUILDING BOX 12 1738 AMARILLO STREET 207-A
SAN JUAN PR
00926
US

IV. Provider business mailing address

1 CALLE TAFT APT. 14-C
SAN JUAN PR
00911-1203
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-0614
  • Fax: 787-281-0632
Mailing address:
  • Phone: 787-281-0614
  • Fax: 787-281-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number918
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: