MEDICARE: DR. ALFONSO 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	30100	CA

General Provider Information

NPI Number	:	1720317902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFONSO GONZALEZ DDS

Provider Business Mailing Address
First Line	:	3988 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1050
Country	:	US
Telephone Number	:	415-334-4554
Fax Number	:	415-333-4243

Provider Business Practice Location Address
First Line	:	3988 MISSION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94112-1050
Country	:	US
Telephone Number	:	415-334-4554
Fax Number	:	415-333-4243

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

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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