Provider Demographics
NPI:1033348115
Name:GONZALEZ, MARITZA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 WEST LOOP S STE 650
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2997
Mailing Address - Country:US
Mailing Address - Phone:713-663-7960
Mailing Address - Fax:713-349-8027
Practice Address - Street 1:3655 FREDRICKSBURG RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3859
Practice Address - Country:US
Practice Address - Phone:210-773-9990
Practice Address - Fax:210-733-1878
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice