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General NPI Number Information
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NPI Number | 1992427082
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Entity Type | Organization
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Legal Business Name | CA GONZALEZ DENTAL CORP
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 620 TWELVE BRIDGES DR STE 120
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City | LINCOLN
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State | CA
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Zip | 95648-8867
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Country | US
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Telephone | 916-996-0384
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Fax |
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Provider Business Mailing Address
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Address Line | 4909 REGAL CT
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City | ROCKLIN
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State | CA
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Zip | 95765-5025
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Country | US
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Telephone | 916-996-0485
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CUAUHTEMOC GONZALEZ
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Credential | DDS
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Telephone | 916-996-0384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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