Provider Demographics
NPI:1255305629
Name:GONZALEZ, ALICIA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:G
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 1:614 S BUSINESS LOOP IH 35
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4741
Mailing Address - Country:US
Mailing Address - Phone:830-625-4121
Mailing Address - Fax:
Practice Address - Street 1:614 S BUSINESS LOOP IH 35
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4741
Practice Address - Country:US
Practice Address - Phone:830-625-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice