Provider Demographics
NPI:1497732457
Name:GONZALEZ, LUIS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ELMHURST STE A
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6397
Mailing Address - Country:US
Mailing Address - Phone:512-722-6131
Mailing Address - Fax:512-262-7717
Practice Address - Street 1:165 ELMHURST STE A
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6397
Practice Address - Country:US
Practice Address - Phone:512-722-6131
Practice Address - Fax:512-262-7717
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist