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General NPI Number Information
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NPI Number | 1205079878
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Entity Type | Individual
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Provider Name | GLORIMAR LLAVONA GONZALEZ D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 18503 PINES BLVD STE 305
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1406
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Country | US
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Telephone | 954-349-4993
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 GLADES CIR STE 3
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City | WESTON
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State | FL
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Zip | 33327-2254
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Country | US
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Telephone | 305-542-5241
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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 | DN17469
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License Number State | FL
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