Provider Demographics
NPI:1508549916
Name:GONZALEZ ULLOA, CARLOS ALAIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ALAIN
Last Name:GONZALEZ ULLOA
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 1:1413 TRUMAN LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046
Mailing Address - Country:US
Mailing Address - Phone:956-452-3047
Mailing Address - Fax:
Practice Address - Street 1:BOCANEGRA 2013
Practice Address - Street 2:
Practice Address - City:NUEVO LAREDO
Practice Address - State:MEXICO
Practice Address - Zip Code:88070
Practice Address - Country:MX
Practice Address - Phone:956-452-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ107462821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice