Provider Demographics
NPI:1356660724
Name:GONZALEZ, MARTIN (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
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 1:7301 STATE HIGHWAY 161
Mailing Address - Street 2:SUITE 198
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2816
Mailing Address - Country:US
Mailing Address - Phone:972-869-3789
Mailing Address - Fax:
Practice Address - Street 1:2401 S STEMMONS FWY
Practice Address - Street 2:#1258
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8775
Practice Address - Country:US
Practice Address - Phone:214-221-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice