Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 22028 | MA |
NPI | 1093984080 |
---|---|
Provider Name | Dario Enrique Gonzalez |
First Address | Dorchester, MA 02124 |
Second Address | Dorchester, MA 02124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2008 |
Last Update Date | 25/02/2008 |