Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 105104 | CA |
NPI | 1720540818 |
---|---|
Provider Name | Dr. Peter Charles Gonzalez |
First Address | Dorris, CA 96023-9100 |
Second Address | Dorris, CA 96023-9100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 10/08/2020 |