Provider Demographics
NPI:1619537461
Name:GONZALEZ, GIOVANNI ANDRE (DMD)
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:ANDRE
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8671 ADDISON PLACE CIR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-7849
Mailing Address - Country:US
Mailing Address - Phone:954-470-7960
Mailing Address - Fax:
Practice Address - Street 1:2300 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2006
Practice Address - Country:US
Practice Address - Phone:239-330-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist