GONZALO E HERNANDEZ (NPI# 1447292537) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447292537 |
| Entity Type | Individual |
| Full Name | GONZALO E HERNANDEZ |
| Credential | D.D.S |
| Practice Address |
2612 E Calumet St Appleton WI 54915-4104 |
| Practice Telephone | 9207396808 |
| Practice Fax Number | 9207307353 |
| Mailing Telephone | 9207396808 |
| Mailing Fax Number | 9207307353 |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
4564-015 | WI | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 33718600 | 05 | |
| DEA # | BH3930903 | 01 |
| Street Address |
2612 E CALUMET ST |
| City | APPLETON |
| State | WI |
| Zip Code | 54915-4104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598105637 | Dental Haven for Children Sc | Dentist | 2612 E Calumet St, Appleton, WI 54915-4104 | 2013-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205466737 | Leyes Robers Dental LLC | Dentist | 3216 W County Rd Kk, Appleton, WI 54915 | 2020-01-23 |
| 1912426958 | Shanna L. Larsen | Registered Nurse | 1101 E. South River St., Appleton, WI 54915 | 2017-09-11 |
| 1477082816 | Amy Fazel | Driver | 226 E Calumet St, Appleton, WI 54915 | 2017-06-08 |
| 1871940213 | B.a.israel LLC | Community Based Residential Treatment Facility, Mental Illness | N9520 Silver Court, Appleton, WI 54915 | 2016-05-16 |
| 1982933479 | Stephanie I. Braski | Counselor | 1531 S. Oneida St, Appleton, WI 54915 | 2009-12-14 |
| 1386808319 | Shawn S Williamson | Emergency Medicine | 1506 South Oneida Street, Appleton, WI 54915 | 2008-07-18 |
| 1700040870 | Heidi Jo Van Toll | Occupational Therapist | 1335 S Oneida Street, Appleton, WI 54915 | 2008-07-17 |
| 1669639142 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | N9642 County Rd N, Appleton, WI 54915 | 2008-05-21 |
| 1265699748 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1531 S Madison St Fl 4, Appleton, WI 54915 | 2008-05-21 |
| 1073770558 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1531 S Madison St Ste 580, Appleton, WI 54915 | 2008-05-21 |
| Find all providers in zip 54915 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710968086 | Children's Dental Health Center, S.c. | Dentist | W3132 Van Roy Rd, Appleton, WI 54915-3982 | 2005-11-14 |
| 1598105637 | Dental Haven for Children Sc | Dentist | 2612 E Calumet St, Appleton, WI 54915-4104 | 2013-07-03 |
| 1922215151 | Mark James Steinmetz | Dentist | W3132 Van Roy Rd, Appleton, WI 54915-3982 | 2007-05-17 |
| 1174730246 | James Arthur Steinmetz | Dentist | W3132 Van Roy Rd, Appleton, WI 54915-3982 | 2007-05-17 |
| 1316968027 | Nikki Smith | Dentist | 4660 W College Ave, Appleton, WI 54913-8507 | 2006-07-21 |
| 1689691560 | Gayatri Bhosale-mohite | Dentist | 4660 W College Ave, Appleton, WI 54913-8507 | 2006-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508478454 | New Richmond Kidds Pediatric Dentistry LLC | Dentist | 1244 N 4th St Ste 300, New Richmond, WI 54017-7540 | 2020-08-21 |
| 1710509484 | Hospital Dentistry for Kids Inc. | Dentist | 4980 S County Rd T, Denmark, WI 54208 | 2020-05-15 |
| 1467808592 | Alexis Colosimo | Dentist | 11035 W Forest Home Ave Ste 116, Hales Corners, WI 53130-2541 | 2016-05-07 |
| 1649676032 | Matina Angelopoulou | Dentist | 1801 West Winsconsin Ave, Milwaukee, WI 53233 | 2014-11-12 |
| 1407257108 | The Kids Dentist LLC | Dentist | 10618 N Port Washington Rd, Mequon, WI 53092-5013 | 2014-09-12 |
| 1144631698 | Jennifer Sinnen | Dentist | 14430 W Greenfield Ave, Brookfield, WI 53005-7036 | 2014-05-17 |
| 1346667045 | David Howard Jadin | Dentist | 1245 Main St, Green Bay, WI 54302 | 2014-03-20 |
| 1396184370 | Adam Joseph Pamer | Dentist | 1320 S Green Bay Rd, Mt Pleasant, WI 53406-4406 | 2013-06-23 |
| 1255628491 | Ronald J Pruhs | Dentist | 4120 S Lake Dr, Apt. 251, Saint Francis, WI 53235-5954 | 2011-07-08 |
| 1982906525 | Jennifer Chun | Dentist | 100 River Pl Ste 110, Monona, WI 53716 | 2010-12-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.