Provider Demographics
NPI:1053556746
Name:MARIA C. GONZALEZ D.D.S., INC
Entity type:Organization
Organization Name:MARIA C. GONZALEZ D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-770-8916
Mailing Address - Street 1:16184 FOOTHILL BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-7400
Mailing Address - Country:US
Mailing Address - Phone:909-770-8916
Mailing Address - Fax:909-770-8919
Practice Address - Street 1:16184 FOOTHILL BLVD STE K
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-7400
Practice Address - Country:US
Practice Address - Phone:909-770-8916
Practice Address - Fax:909-770-8919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIA C. GONZALEZ D.D.S., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty