Individual
KELLY GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
12801 W SUNRISE BLVD, F222, SUNRISE, FL 33323-4020
(954) 846-7171
(954) 846-7129
Mailing address
511 SE 5TH AVE APT 1122, FORT LAUDERDALE, FL 33301-2972
(561) 212-8478
(954) 846-7129
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN20710
FL
1223G0001X
General Practice Dentistry
DN20170
FL
Other
Enumeration date
07/09/2014
Last updated
04/30/2019
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