Lisset Gonzalez, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 21892 Issued in FL

Practice address

1462 W Granada Blvd Ste 210
Ormond Beach, FL 32174-9167

Phone

(386) 675-1711

NPI assigned

Jun 10, 2016

Last updated

Jun 10, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Lisset Perez Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465516800000",
    "number": "1376992230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1462 W GRANADA BLVD STE 210",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321749167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1462 W GRANADA BLVD STE 210",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321749167",
            "telephone_number": "386-675-1711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "LISSET",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-10",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 21892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISSET",
            "last_name": "PEREZ",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Luis Gomez, ARNP
• Lisa Gonsalves, M.D.
• Maria Gontcharova, MD
• Evelyn Gonzalez, PTA
• Laura Lyann Gonzalez, ARNP
• Sarah Elizabeth Goodman, ARNP
• Amy Goodpasture
• Tiffany D Googin
• B. Scott Goralnik, ORTHOTIC FITTER
• Kim M Goss, COTA

• General Practice Dentistry in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.