Provider Demographics
NPI:1487643482
Name:VON GONTEN, ANN SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:SUE
Last Name:VON GONTEN
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:2410 STANLEY RD
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY, SUITE 200J
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6230
Mailing Address - Country:US
Mailing Address - Phone:210-295-2743
Mailing Address - Fax:210-295-2602
Practice Address - Street 1:2410 STANLEY RD
Practice Address - Street 2:US ARMY DENTAL ACTIVITY, SUITE 200J
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6230
Practice Address - Country:US
Practice Address - Phone:210-295-2743
Practice Address - Fax:210-295-2602
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC52471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics