MEDICARE: GONZALEZ AND CARLOS A PROFESSIONAL DENTAL CORP

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	122300000X	Dentist	D39342	CA

General Provider Information

NPI Number	:	1518160712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GONZALEZ AND CARLOS A PROFESSIONAL DENTAL CORP

Provider Business Mailing Address
First Line	:	532 N MILPAS ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-3137
Country	:	US
Telephone Number	:	805-884-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 N MILPAS ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93103-3137
Country	:	US
Telephone Number	:	805-884-0111
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MARIA DE LOURDES CARLOS
Credential	:	D.D.S.
Telephone Number	:	805-884-0111

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	05/02/2014

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