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General NPI Number Information
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NPI Number | 1447786462
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Entity Type | Individual
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Provider Name | REINIER TEJEDA GONZALEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 249 PALM BAY RD NE
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-8602
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Country | US
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Telephone | 321-482-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 541 PORT MALABAR BLVD NE
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City | PALM BAY
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State | FL
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Zip | 32905-4406
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Country | US
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Telephone | 321-557-4573
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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 | DN24324
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License Number State | FL
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