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General NPI Number Information
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NPI Number | 1679268866
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Entity Type | Individual
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Provider Name | ANNA GONZALES
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Gender | Female
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 824 N MAIN ST
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City | ROSWELL
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State | NM
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Zip | 88201-4969
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Country | US
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Telephone | 575-622-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 208 W KEMP AVE
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City | ARTESIA
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State | NM
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Zip | 88210-1024
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Country | US
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Telephone | 575-308-6204
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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 | DB-2023-0100
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License Number State | NM
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