Individual
GABRIEL PEREZ-GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
195 GREENCASTLE RD, TYRONE, GA 30290-2938
(770) 486-5585
Mailing address
195 GREENCASTLE RD, TYRONE, GA 30290-2938
(770) 486-5585
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122741
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21418122332
MADICAID
GA
05
—
21418122332
—
GA
Enumeration date
06/28/2022
Last updated
06/28/2022
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