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General NPI Number Information
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NPI Number | 1902071210
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Entity Type | Organization
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Legal Business Name | CLARA M. GONZALEZ, D.M.D. P.A.
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 6532 NW 186TH ST
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City | HIALEAH
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State | FL
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Zip | 33015-6004
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Country | US
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Telephone | 306-362-4717
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Fax | 305-362-4880
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Provider Business Mailing Address
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Address Line | 6532 NW 186TH ST
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City | HIALEAH
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State | FL
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Zip | 33015-6004
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Country | US
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Telephone | 306-362-4717
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Fax | 305-362-4880
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLARA M. GONZALEZ
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Credential | D.M.D.
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Telephone | 305-362-4717
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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 | DN11268
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License Number State | FL
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