Edward D Gonzales, DDS

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

033770 Issued in CA

Practice address

100 Lake Traverse Dr
Sisseton, SD 57262-0189

Phone

(605) 742-3678

Fax

(605) 742-3887

NPI assigned

Oct 20, 2006

Last updated

Dec 23, 2011By 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 TX

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

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.

• Woodrow Wilson Keeble Memorial Health Care Center

  • Clinic/Center
  • Sisseton, SD
  • NPI 1366471666

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324598400000",
    "number": "1841372471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 15TH ST N",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580753519",
            "telephone_number": "701-642-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LAKE TRAVERSE DR",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572620189",
            "telephone_number": "605-742-3678",
            "fax_number": "605-742-3887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "EDWARD",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2011-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "CA",
            "license": "033770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Pauline Francis, RPH
• Jennifer Marie Fuhr, RT(R)
• Stanley C Gallagher, DO
• Jamie Veronica German, L.P.N
• Kasandra Rachelle Girard, ED.S., NCSP
• Liberty Ann Derby Goodsell, LPN
• Patricia Ann Goodshield Oceguera, LPN
• Greenleaf Assisted Living, Inc.
• Royce L. Grimsrud, O.D.
• Whitney Briar Haanen, RN,BSN

• Public Health Dentistry in Sisseton, SD
• Providers in Sisseton, SD by specialty
• Public Health Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2011; 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.