Edith Socorro Gonzalez Jaimes, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

0401417411 Issued in VA

Practice address

121 Park Hill Dr.
Suite a
Fredericksburg, VA 22401

Phone

(540) 373-1660

NPI assigned

Apr 26, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Heritage Moore - Ams, PLLC

  • Dental Clinic/Center
  • Fredericksburg, VA
  • NPI 1720894629
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1013405992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4947",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "23058",
            "telephone_number": "540-223-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 PARK HILL DR.",
            "address_2": "SUITE A",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "22401",
            "telephone_number": "540-373-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ JAIMES",
        "first_name": "EDITH",
        "middle_name": "SOCORRO",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-26",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401417411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Philip Golka, DDS
• Benita Gollamudi
• Nagalatha Gollapalli, DDS
• Golver Dialysis LLC
• George Tendero Gonzales, MD
• Irma Gonzalez Medrano, RBT
• Conrado C Gonzalez Jr., MD
• Evan Gonzalez, PA-C
• Jonathan Kenneth Gonzalez, MD
• Luz Amalya Gonzalez, CSAC, RESIDENT IN CO

• Dentist in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.