Basic Information
| Provider Information | |||||||||
| NPI: | 1578174462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ ESCALONA | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | ALIANA | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 N FEDERAL HWY APT 267H | ||||||||
| Address2: | |||||||||
| City: | LIGHTHOUSE POINT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330646554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7686025806 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 S UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333282018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542627663 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2020 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | DRP2233 | FL | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.