MEDICARE: GOZON DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1679436083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOZON DENTAL PLLC

Provider Business Mailing Address
First Line	:	208 THALIA RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5333 INDIAN RIVER RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5320
Country	:	US
Telephone Number	:	757-420-1507
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RAYMOND GOZON
Credential	:	DMD
Telephone Number	:	757-687-9166

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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