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General NPI Number Information
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NPI Number | 1366567539
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Entity Type | Individual
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Provider Name | JORGE R GONZALEZ DMD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 2349 CHERRY RD STE 49
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City | ROCK HILL
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State | SC
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Zip | 29732-2132
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Country | US
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Telephone | 803-721-9179
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Fax |
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Provider Business Mailing Address
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Address Line | 2349 CHERRY RD STE 49
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City | ROCK HILL
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State | SC
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Zip | 29732-2132
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Country | US
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Telephone | 803-721-9179
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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 | 2232
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 34542
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License Number State | TX
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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 | 8609
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License Number State | SC
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