| Gonzalez Professional Dental Corporation | |
|
2010 Wilshire Blvd Ste.# 512 Los Angeles CA 90057-3507 | |
| (213) 413-1283 | |
| (213) 413-0982 |
| Full Name | Gonzalez Professional Dental Corporation |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2010 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Aleli Escalante Gonzalez (D.D.S.) |
| Authorized Official Contact | 2134131283 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gonzalez Professional Dental Corporation 2010 Wilshire Blvd Ste.# 512 Los Angeles CA 90057-3507 Ph: (213) 413-1283 | Gonzalez Professional Dental Corporation 2010 Wilshire Blvd Ste.# 512 Los Angeles CA 90057-3507 Ph: (213) 413-1283 |
| NPI Number | 1558489849 |
|---|---|
| Provider Enumeration Date | 03/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558489849 | NPI | - | NPPES |
| G94018-01 | Other | CA | MEDI-CAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 46260 (California) | Primary |
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