Provider Demographics
NPI:1215009451
Name:GONZALES, DAVID A (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 OAKWELL FARMS PKWY
Mailing Address - Street 2:#240
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1777
Mailing Address - Country:US
Mailing Address - Phone:210-824-6787
Mailing Address - Fax:210-824-2652
Practice Address - Street 1:1919 OAKWELL FARMS PKWY
Practice Address - Street 2:240
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218
Practice Address - Country:US
Practice Address - Phone:210-824-6787
Practice Address - Fax:210-824-2652
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22110122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175160402OtherC DC
89D485OtherBLUE CROSS BLUE SHIELD
1766422OtherUNITED CONCORDIA
TX175160401Medicaid