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General NPI Number Information
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NPI Number | 1992154983
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Entity Type | Organization
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Legal Business Name | TOM GONZALEZ DENTAL CORPORATION
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 113 WATERWORKS WAY STE 220
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City | IRVINE
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State | CA
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Zip | 92618-3176
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Country | US
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Telephone | 949-727-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 113 WATERWORKS WAY STE 220
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City | IRVINE
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State | CA
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Zip | 92618
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Country | US
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Telephone | 949-727-0777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS GONZALES
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Credential |
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Telephone | 949-727-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 26408
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License Number State | CA
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