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Individual

DR. JUAN RAFAEL GONZALEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
502 BALDORIOTY ST, ISABEL II, VIEQUES, PR 00765
(787) 318-7376
Mailing address
PO BOX 608, VIEQUES, PR 00765-0608
(787) 318-7376

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
019-022361
IL
122300000X
Dentist
042540
NY
122300000X
Dentist
17336-9
TX
122300000X
Dentist
Primary
30-022496
OH
122300000X
Dentist
856
PR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
008682
REGISTRATION NUM.
PR
01
856
DENTAL LICENCE
PR
Enumeration date
08/15/2006
Last updated
07/12/2012
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