Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401411136 | VA |
NPI | 1003567678 |
---|---|
Provider Name | Rose Marie Gonzales |
First Address | Framingham, MA 01702-5555 |
Second Address | Hampton, VA 23666-2074 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2022 |
Last Update Date | 14/01/2022 |