Provider Demographics
NPI:1093729568
Name:GONZALEZ, RAYMOND EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:EDWARD
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 BON AIRE AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4423
Mailing Address - Country:US
Mailing Address - Phone:361-579-9590
Mailing Address - Fax:
Practice Address - Street 1:3506 N BEN WILSON ST STE A
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4448
Practice Address - Country:US
Practice Address - Phone:361-579-9585
Practice Address - Fax:361-579-9588
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics