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Individual

RICARDO L VIDAL GONZALEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
118 SEARS AVE, LOUISVILLE, KY 40207-5014
(502) 296-7536
Mailing address
3416 HANOVER CT, LOUISVILLE, KY 40207-4326
(502) 296-7536

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
12013412A
IN
1223P0300X
Periodontics
30.024338
OH
1223P0300X
Periodontics
Primary
8281
KY

Other

Enumeration date
02/01/2007
Last updated
12/12/2021
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