Basic Information
| Provider Information | |||||||||
| NPI: | 1700449600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | JESICA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 34TH ST STE AND200 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8336782781 | ||||||||
| FaxNumber: | 6613680618 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 34TH ST STE AND200 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8336782781 | ||||||||
| FaxNumber: | 6613680618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2019 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | DDS104560 | CA | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.