Active NPI
Eduardo Gentry Gonzalez, DMD
- General Practice Dentistry
- Birmingham, AL
National Provider Identifier
1790883155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4983
- Practice address
- 2633 Valleydale Rd
Suite 250
Birmingham, AL 35244-2714 - Phone
- (205) 991-7797
- Fax
- (205) 995-9994
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4983 | AL | Primary |
Addresses
Primary practice location
2633 Valleydale Rd
Suite 250
Birmingham, AL 35244-2714
Mailing address
2633 Valleydale Rd
Suite 250
Birmingham, AL 35244-2714
Phone (205) 991-7797
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31965 | Other | AL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4983 | AL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214784000000",
"number": "1790883155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2633 VALLEYDALE RD",
"address_2": "SUITE 250",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352442714",
"telephone_number": "205-991-7797",
"fax_number": "205-995-9994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2633 VALLEYDALE RD",
"address_2": "SUITE 250",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352442714",
"telephone_number": "205-991-7797",
"fax_number": "205-995-9994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "EDUARDO",
"middle_name": "GENTRY",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2008-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AL",
"license": "4983",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "31965",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.