MEDICARE: CLARA M. GONZALEZ, D.M.D. P.A.

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	DN11268	FL

General Provider Information

NPI Number	:	1902071210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARA M. GONZALEZ, D.M.D. P.A.

Provider Business Mailing Address
First Line	:	6532 NW 186TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6004
Country	:	US
Telephone Number	:	306-362-4717
Fax Number	:	305-362-4880

Provider Business Practice Location Address
First Line	:	6532 NW 186TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6004
Country	:	US
Telephone Number	:	306-362-4717
Fax Number	:	305-362-4880

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLARA M. GONZALEZ
Credential	:	D.M.D.
Telephone Number	:	305-362-4717

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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