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General NPI Number Information
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NPI Number | 1043479843
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Entity Type | Organization
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Legal Business Name | JAIME GONZALEZ DDS INC
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 1516 MAIN ST STE 106A
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City | RAMONA
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State | CA
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Zip | 92065-5242
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Country | US
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Telephone | 780-787-0962
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Fax | 760-787-0851
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Provider Business Mailing Address
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Address Line | 1516 MAIN ST STE 106A
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City | RAMONA
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State | CA
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Zip | 92065-5242
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Country | US
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Telephone | 780-787-0962
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Fax | 760-787-0851
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. ANA PATRICIA LOPEZ
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Credential |
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Telephone | 617-309-0291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 55982
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License Number State | CA
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