Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5379-015 | WI |
NPI | 1023005972 |
---|---|
Provider Name | Dr. Cesar D Gonzalez |
First Address | Brookfield, WI 53005-8025 |
Second Address | Kenosha, WI 53140-5917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33779500 | (05) | WI |