Individual
JESSICA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4410 W 16TH AVE STE 52, HIALEAH, FL 33012-7193
(305) 825-9899
Mailing address
609 SW 5TH AVE, FORT LAUDERDALE, FL 33315-1023
(305) 302-4148
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
22DI02980200
NJ
1223P0221X
Pediatric Dentistry
Primary
DN26610
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/30/2021
Last updated
06/16/2025
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