Edelio Gonzalez DMD, PA

Primary specialty

DentistTaxonomy code 122300000X

License

DN00013074 Issued in FL

Legal business name

EDELIO GONZALEZ DMD, PA

Practice address

1191 W 37TH St
5
Hialeah, FL 33012-4941

Phone

(305) 826-9642

Fax

(305) 819-8014

NPI assigned

Sep 28, 2006

Organization subpart

No

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

Authorized official

Name

Edelio Gonzalez, DMD

Title

President

Phone

(305) 826-9642

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871684183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 W 37TH ST",
            "address_2": "5",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330124941",
            "telephone_number": "305-826-9642",
            "fax_number": "305-819-8014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 W 37TH ST",
            "address_2": "5",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330124941",
            "telephone_number": "305-826-9642",
            "fax_number": "305-819-8014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDELIO GONZALEZ DMD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "EDELIO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-826-9642",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN00013074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0171853000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.