MEDICARE: DR. ELIZABETH GONZALEZ D.D.S

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	14937	MD
2	122300000X	Dentist	DN19668	FL
3	122300000X	Dentist	3947	WV

General Provider Information

NPI Number	:	1275826117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH GONZALEZ D.D.S

Provider Business Mailing Address
First Line	:	1951 SW 12TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33129-2633
Country	:	US
Telephone Number	:	305-989-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 BISHOP MURPHY DR
Second Line	:
City	:	FROSTBURG
State	:	MD
Zip	:	21532-1329
Country	:	US
Telephone Number	:	301-689-6780
Fax Number	:	301-687-8011

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

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/09/2012

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Directions to “ DR. ELIZABETH GONZALEZ D.D.S” Practice Location

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