Individual
JOSE ANTONIO GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
888 THACKERAY TRL STE 214, OCONOMOWOC, WI 53066-4342
(262) 567-9116
(262) 567-5870
Mailing address
5646 S 45TH ST, GREENFIELD, WI 53220-5209
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1002705
WI
Other
Enumeration date
05/18/2021
Last updated
09/18/2024
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