Laurel Gonzales

Primary specialty

DentistTaxonomy code 122300000X

License

7017-15 Issued in WI

Practice address

1595 Allouez Ave
Green Bay, WI 54311-6267

Phone

(515) 570-7052

NPI assigned

Nov 15, 2012

Last updated

Jan 30, 2013By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359504000000",
    "number": "1710221635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "943 S MADISON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013612",
            "telephone_number": "515-570-7052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 ALLOUEZ AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116267",
            "telephone_number": "515-570-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "LAUREL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2013-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "08979",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "7017-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Nicole Golden, SURGICAL TECH
• Kelly Elizabeth Gole, PHARMD
• Rose Gontarz
• Mark Edward Gonyo, D.D.S.
• Teresa A Gonzaga, MD
• Jessica Gonzalez Monroe, DC
• Nicholas Andrew Gonzalez, NREMT
• Good Care,Inc.
• Good for the Soul Therapeutic Music
• Abigail N Good, OT

• Dentist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; 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.