# GONZALES DENTAL CORPORATION

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

## Provider details

- **NPI number:** 1285002048
- **Authorized official:** DR. THOMAS RICHARD GONZALES DDS (PRESIDENT)
- **Authorized official phone:** (858) 521-0000

## Contact information

- **Practice address:** 11968 BERNARDO PLAZA DRIVE, SAN DIEGO, CA 92128
- **Practice address phone:** (858) 521-0000
- **Practice address fax:** (858) 521-0404
- **Mailing address:** 11968 BERNARDO PLAZA DRIVE, SAN DIEGO, CA 92128
- **Mailing address phone:** (858) 521-0000
- **Mailing address fax:** (858) 521-0404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 26408 | CA | Yes |

## Other

- **Enumeration date:** 09/10/2015
- **Last updated:** 11/13/2015