Organization
TOM GONZALEZ DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GONZALES (OWNER)
(949) 727-0777
Entity
Organization
Contact information
Practice address
113 WATERWORKS WAY STE 220, IRVINE, CA 92618-3176
(949) 727-0777
Mailing address
113 WATERWORKS WAY STE 220, IRVINE, CA 92618
(949) 727-0777
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
26408
CA
Other
Enumeration date
06/09/2016
Last updated
04/13/2017
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