Individual
LAUREL GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1595 ALLOUEZ AVE, GREEN BAY, WI 54311-6267
(515) 570-7052
Mailing address
943 S MADISON ST, GREEN BAY, WI 54301-3612
(515) 570-7052
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
08979
IA
122300000X
Dentist
Primary
7017-15
WI
Other
Enumeration date
11/15/2012
Last updated
01/30/2013
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