Individual
MRS. THERESE A GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
412 EDISON, BRUSH, CO 80723
(970) 842-0220
Mailing address
PO BOX 563, BRUSH, CO 80723
(970) 842-0220
(970) 842-0224
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
904552
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01335537
—
CO
Enumeration date
09/26/2006
Last updated
11/07/2018
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