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General NPI Number Information
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NPI Number | 1689876476
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Entity Type | Organization
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Legal Business Name | JOSE R. GONZALES. D.D.S. P.C.
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3060 N. LITCHFIELD ROAD SUITE 110
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City | GOODYEAR
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State | AZ
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Zip | 85338
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Country | US
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Telephone | 623-547-0403
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Fax | 623-935-0944
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Provider Business Mailing Address
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Address Line | 3060 N LITCHFIELD ROAD SUITE 110
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City | GOODYEAR
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State | AZ
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Zip | 85338
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Country | US
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Telephone | 623-547-0403
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Fax | 623-935-0944
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE RIVAS GONZALES
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Credential | D.D.S.
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Telephone | 623-547-0403
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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 | D4678
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License Number State | AZ
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