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General NPI Number Information
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NPI Number | 1083255111
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Entity Type | Individual
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Provider Name | WAYNE DAVID GONZALES DDS
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Gender | Male
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 8031 LINDA VISTA RD # 210
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City | SAN DIEGO
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State | CA
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Zip | 92111-5110
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Country | US
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Telephone | 858-268-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 3732 WESTWOOD BLVD APT 5
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City | LOS ANGELES
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State | CA
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Zip | 90034-6720
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Country | US
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Telephone | 310-948-5765
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 104439
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License Number State | CA
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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 | 104439
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License Number State | CA
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