Organization
TRGONZALES DDS DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GONZALES DDS (AUTHORIZED OFFICIAL)
(626) 872-6352
Entity
Organization
Contact information
Practice address
416 W LAS TUNAS DR STE 107, SAN GABRIEL, CA 91776-1236
(626) 872-6352
Mailing address
416 W LAS TUNAS DR STE 107, SAN GABRIEL, CA 91776-1236
(626) 872-6352
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
11/23/2022
Last updated
11/23/2022
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