# GONZALEZ DENTAL LAB

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093188856
- **Authorized official:** MR. PEDRO P GONZALEZ (OWNER)
- **Authorized official phone:** (305) 975-1292

## Contact information

- **Practice address:** 921 SW 122ND AVE, MIAMI, FL 33184-2477
- **Practice address phone:** (305) 975-1292
- **Mailing address:** 1065 NW 129TH AVE, MIAMI, FL 33182-2324
- **Mailing address phone:** (305) 975-1292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | DL 11401 | FL | Yes |

## Other

- **Enumeration date:** 11/02/2015
- **Last updated:** 11/02/2015