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General NPI Number Information
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NPI Number | 1043433188
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Entity Type | Individual
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Provider Name | PATRICIO E. GONZALEZ-MARIN DDS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 501 28TH ST
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City | DENVER
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State | CO
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Zip | 80205-3003
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Country | US
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Telephone | 303-436-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 501 28TH ST
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City | DENVER
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State | CO
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Zip | 80205-3003
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Country | US
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Telephone | 303-436-4600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 200609039343
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10131
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License Number State | CO
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