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General NPI Number Information
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NPI Number | 1518160712
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Entity Type | Organization
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Legal Business Name | GONZALEZ AND CARLOS A PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 532 N MILPAS ST
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City | SANTA BARBARA
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State | CA
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Zip | 93103-3137
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Country | US
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Telephone | 805-884-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 532 N MILPAS ST
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City | SANTA BARBARA
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State | CA
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Zip | 93103-3137
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Country | US
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Telephone | 805-884-0111
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARIA DE LOURDES CARLOS
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Credential | D.D.S.
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Telephone | 805-884-0111
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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 | D39342
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License Number State | CA
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