Provider Demographics
NPI:1275125791
Name:GONZALEZ FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:GONZALEZ FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-562-5347
Mailing Address - Street 1:P O BOX 350
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667
Mailing Address - Country:US
Mailing Address - Phone:254-562-5347
Mailing Address - Fax:254-560-5041
Practice Address - Street 1:300 N. SHERMAN ST.
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667
Practice Address - Country:US
Practice Address - Phone:254-562-5347
Practice Address - Fax:254-562-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty