Ricardo L Vidal Gonzalez

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

8281 Issued in KY

Practice address

118 Sears Ave
Louisville, KY 40207-5014

Phone

(502) 296-7536

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639267200000",
    "number": "1295873479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3416 HANOVER CT",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074326",
            "telephone_number": "502-296-7536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 SEARS AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402075014",
            "telephone_number": "502-296-7536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4000 Charlestown Crossing Way",
            "address_purpose": "LOCATION",
            "city": "New Albany",
            "state": "IN",
            "postal_code": "471508300",
            "country_code": "US",
            "telephone_number": "502-296-7536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIDAL GONZALEZ",
        "first_name": "RICARDO",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2021-12-12",
        "certification_date": "2021-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OH",
            "license": "30.024338",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IN",
            "license": "12013412A",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "KY",
            "license": "8281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Vicknair
• Victoria Hatfield LLC
• Victoria Yunker MD
• Victoria Yunker, MD
• Vida Medical Care LLC
• Navjyot Kaur Vidwan, M.D.
• Viemed Clinical Services, LLC
• Jeanne Viers, APRN
• Juan Villafane, M.D.
• Juan Carlos Villalobos, MDM

• Periodontics in Louisville, KY
• Providers in Louisville, KY by specialty
• Periodontics in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.