Individual
DR. EDWARD JOHANN GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
307 BOATNER RD STE 114, 96TH MDG/SGDR, EGLIN AFB, FL 32542-1302
(850) 883-8785
Mailing address
590 MITCHELL BLVD, 47 ADS/SGGD, LAUGHLIN AFB, TX 78843-5242
(830) 298-6398
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
23956
TX
390200000X
Student in an Organized Health Care Education/Training Program
23956
TX
Other
Enumeration date
12/03/2008
Last updated
09/29/2009
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