Provider Demographics
NPI:1326013616
Name:GONZALES, JULIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:
Last Name:GONZALES
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:CDR U.S. ARMY DENTAL ACTIVITY
Mailing Address - Street 2:CMR 489 BOX 2604
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CDR US ARMY DENTAL ACTIVITY
Practice Address - Street 2:CMR 489 BOX 2604
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09128
Practice Address - Country:US
Practice Address - Phone:314-371-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics