MEDICARE: DR. ARTURO GONZALEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DGP556134	ZZ

General Provider Information

NPI Number	:	1205078631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTURO GONZALEZ DDS

Provider Business Mailing Address
First Line	:	995 ROSAL CT
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-8030
Country	:	US
Telephone Number	:	619-739-4365
Fax Number	:	619-271-2006

Provider Business Practice Location Address
First Line	:	MISION DE LORETO # 2962-204
Second Line	:
City	:	TIJUANA
State	:	B.C
Zip	:	22010
Country	:	MX
Telephone Number	:	664-634-2060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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