MEDICARE: DR. JOSE GILBERTO GONZALEZ-GONZALEZ D.M.D

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	1223P0300X	Periodontics	918	PR

General Provider Information

NPI Number	:	1992892244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE GILBERTO GONZALEZ-GONZALEZ D.M.D

Provider Business Mailing Address
First Line	:	1 CALLE TAFT
Second Line	:	APT. 14-C
City	:	SAN JUAN
State	:	PR
Zip	:	00911-1203
Country	:	US
Telephone Number	:	787-281-0614
Fax Number	:	787-281-0632

Provider Business Practice Location Address
First Line	:	SUMMIT BUILDING BOX 12 1738 AMARILLO STREET
Second Line	:	207-A
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-281-0614
Fax Number	:	787-281-0632

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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