Healthcare Provider Details

I. General information

NPI: 1114906484
Provider Name (Legal Business Name): GEORGE ANDREW GONZALEZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW AMERICAN LAKE VAMC (A-112-DENT)
TACOMA WA
98493-0003
US

IV. Provider business mailing address

70 SILVER BEACH DR
STEILACOOM WA
98388-1520
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-4005
  • Fax:
Mailing address:
  • Phone: 253-584-9525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number39801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: