Doctor Name: | DR. EDWARD JOHANN GONZALEZ |
NPI Number: | 1790920916 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | 23956 |
Business Practice Address: | 307 Boatner Rd Ste 114 96th Mdg/sgdr Eglin Afb, FL - 325421302 |
Business Phone Number: | 8508838785 |
Business Fax Number: | |
Mailing Address: | 590 Mitchell Blvd, 47 Ads/sggd LAUGHLIN AFB |
State: | TX |
Postal Code: | 788435242 |
Phone Number: | 8302986398 |
Fax Number: | |
NPI Enumeration Date: | 12/03/2008 |
NPI Last Update Date: | 09/29/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 23956 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |