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General NPI Number Information
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NPI Number | 1245690759
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Entity Type | Organization
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Legal Business Name | R. O. GONZALEZ DDS, INC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 29798 HAUN RD SUITE 101
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City | MENIFEE
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State | CA
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Zip | 92586
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Country | US
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Telephone | 951-672-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 29798 HAUN RD. SUITE 101
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City | MENIFEE
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State | CA
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Zip | 92586
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Country | US
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Telephone | 951-672-9799
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Fax | 951-672-9691
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROLANDO OSCAR GONZALEZ
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Credential | DDS
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Telephone | 951-672-9799
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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 | 33202
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License Number State | CA
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