Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 39801 | CA |
NPI | 1114906484 |
---|---|
Provider Name | Dr. George Andrew Gonzalez |
First Address | Steilacoom, WA 98388-1520 |
Second Address | Tacoma, WA 98493-0003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 08/07/2007 |