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General NPI Number Information
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NPI Number | 1225898042
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Entity Type | Individual
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Provider Name | LIANET GONZALEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 2265 AUGUSTA RD
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4523
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Country | US
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Telephone | 803-486-2612
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Fax |
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Provider Business Mailing Address
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Address Line | 255 LAURELBROOK DR
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City | CHAPIN
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State | SC
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Zip | 29036-9285
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Country | US
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Telephone | 305-586-0048
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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 | 11085
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License Number State | SC
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