Provider Demographics
NPI:1497287536
Name:GONZALEZ FUENTES, TANIA DENISSE (DMD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:DENISSE
Last Name:GONZALEZ FUENTES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 2 MARGINAL 272
Mailing Address - Street 2:EDIF TROPICAL PLAZA SUITE 3
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0000
Mailing Address - Country:US
Mailing Address - Phone:787-262-5600
Mailing Address - Fax:
Practice Address - Street 1:TROPICAL PLAZA SUITE 3
Practice Address - Street 2:STREET 2 MARGINAL 272
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:787-690-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR32851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program