MEDICARE: DR. GABRIELLA 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	122300000X	Dentist	14224469-9926	UT

General Provider Information

NPI Number	:	1629861828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELLA GONZALEZ DDS

Provider Business Mailing Address
First Line	:	343 S 1300 E APT 1
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2690
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E SOUTH TEMPLE STE 410
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1364
Country	:	US
Telephone Number	:	801-783-3321
Fax Number	:

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

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	05/28/2025

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