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General NPI Number Information
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NPI Number | 1083576433
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Entity Type | Individual
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Provider Name | GARRET GONZALES DDS
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Gender | Male
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 4171 CRESCENT DR STE 102
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City | SAINT LOUIS
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State | MO
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Zip | 63129-3645
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Country | US
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Telephone | 314-200-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 9616 BENT PINE DR APT A
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City | SAPPINGTON
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State | MO
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Zip | 63126-3346
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Country | US
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Telephone | 208-420-4213
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2025049199
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License Number State | MO
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