Provider Demographics
NPI:1801588090
Name:YANES GONZALEZ, CARLOS (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:YANES 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 1:3890 SW 64TH AVE APT 358
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-2587
Mailing Address - Country:US
Mailing Address - Phone:786-619-5587
Mailing Address - Fax:
Practice Address - Street 1:1625 E LAS OLAS BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2357
Practice Address - Country:US
Practice Address - Phone:954-463-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist