Edward Johann Gonzalez, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

23956 Issued in TX

Practice address

307 Boatner Rd Ste 114
96TH MDG/SGDR
Eglin AFB, FL 32542-1302

Phone

(850) 883-8785

NPI assigned

Dec 3, 2008

Last updated

Sep 29, 2009By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254182400000",
    "number": "1790920916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 MITCHELL BLVD",
            "address_2": "47 ADS/SGGD",
            "city": "LAUGHLIN AFB",
            "state": "TX",
            "postal_code": "788435242",
            "telephone_number": "830-298-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD STE 114",
            "address_2": "96TH MDG/SGDR",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302",
            "telephone_number": "850-883-8785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "EDWARD",
        "middle_name": "JOHANN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-03",
        "last_updated": "2009-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "23956",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "23956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra L Gillard
• Gemma P Gilman
• Lekeyna Gleason, DNP, FNP, RN
• Joanne Marie Gold, PHARMD
• Stephanie B Golden, PSYD
• Sapna Gopalasubramanian, MD
• Lauren Alyssa Gould, DO
• Michael Sean Grady, FNP-C
• John Skyler Graham
• Kleve Woods Granger, MD

• Dentist in Eglin AFB, FL
• Providers in Eglin AFB, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; 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.