Provider Demographics
NPI:1346561560
Name:GONZALEZ, ANTHONY BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BENJAMIN
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 1:13725 NORTHWEST BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-3745
Mailing Address - Country:US
Mailing Address - Phone:361-387-1507
Mailing Address - Fax:361-387-2470
Practice Address - Street 1:13725 NORTHWEST BLVD STE 220
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-3745
Practice Address - Country:US
Practice Address - Phone:361-387-1507
Practice Address - Fax:361-387-2470
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice