Individual
DR. EDWIN GONZALEZ MONTOYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OMFS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019031410
IL
1223G0001X
General Practice Dentistry
019031410
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021002849
IL
Other
Enumeration date
10/07/2017
Last updated
12/07/2017
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