Jose Antonio Gonzalez, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1002705 Issued in WI

Practice address

888 Thackeray TRL Ste 214
Oconomowoc, WI 53066-4342

Phone

(262) 567-9116

Fax

(262) 567-5870

NPI assigned

May 18, 2021

Last updated

Sep 18, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• John T Bitner DDS LLC

  dba Bitner Family Dentistry

  • General Practice Dentistry
  • Oconomowoc, WI
  • NPI 1871305466
  NPD
• Oconomowoc Dental Anesthesia Center

  • Oral and Maxillofacial Surgery Clinic/Center
  • Oconomowoc, WI
  • NPI 1053972661
  NPD (past)

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

{
    "created_epoch": "1621296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1508430091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5646 S 45TH ST",
            "city": "GREENFIELD",
            "state": "WI",
            "postal_code": "532205209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 THACKERAY TRL STE 214",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664342",
            "telephone_number": "262-567-9116",
            "fax_number": "262-567-5870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "JOSE",
        "middle_name": "ANTONIO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1002705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genoa Healthcare LLC
• Heather Gershteyn, PHARM.D.
• Firas Ghanem, M.D.
• Karalyn Ginster
• Jeffery N Glaspy, MD
• Ella Gorgan
• Karen Ihry Gould, D.C.
• Beth Ann Gramz, RDH
• Brittany Morgan Greig, MMT, CPT, MT
• Mark J Grevlich, DDS

• General Practice Dentistry in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.