Provider Demographics
NPI:1730862020
Name:GONZALEZ, MIGUEL ALONZO (DDS)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ALONZO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18913 E VINE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3532
Mailing Address - Country:US
Mailing Address - Phone:714-597-1660
Mailing Address - Fax:
Practice Address - Street 1:18913 E VINE AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3532
Practice Address - Country:US
Practice Address - Phone:714-597-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist