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General NPI Number Information
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NPI Number | 1235473018
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Entity Type | Individual
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Provider Name | ASTRID IVETTE GONZALEZ DDS
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Gender | Female
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 4052 BALD CYPRESS WAY BIN A14 DENTAL PUBLIC HEALTH DEPT
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City | TALLAHASSEE
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State | FL
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Zip | 32399-1724
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Country | US
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Telephone | 850-245-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 4052 BALD CYPRESS WAY BIN A14 DENTAL PUBLIC HEALTH DEPT
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City | TALLAHASSEE
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State | FL
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Zip | 32399-1724
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Country | US
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Telephone | 850-245-4444
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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 | DS040107
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 22443
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02508200
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License Number State | NJ
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