Provider Demographics
NPI:1407010820
Name:GONZALEZ DENTAL CENTER
Entity Type:Organization
Organization Name:GONZALEZ DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:713-644-0234
Mailing Address - Street 1:PO BOX 12668
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77217-2668
Mailing Address - Country:US
Mailing Address - Phone:713-644-0234
Mailing Address - Fax:713-644-0767
Practice Address - Street 1:8470 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-5094
Practice Address - Country:US
Practice Address - Phone:713-644-0234
Practice Address - Fax:713-644-0767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17986305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization