Provider Demographics
NPI:1235473018
Name:GONZALEZ, ASTRID IVETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:IVETTE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4052 BALD CYPRESS WAY BIN A14
Mailing Address - Street 2:DENTAL PUBLIC HEALTH DEPT
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32399-1724
Mailing Address - Country:US
Mailing Address - Phone:850-245-4444
Mailing Address - Fax:
Practice Address - Street 1:4052 BALD CYPRESS WAY BIN A14
Practice Address - Street 2:DENTAL PUBLIC HEALTH DEPT
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32399-1724
Practice Address - Country:US
Practice Address - Phone:850-245-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040107122300000X
FLDN 22443122300000X
NJ22DI025082001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice