Provider Demographics
NPI:1629465513
Name:GONZALEZ ANGELI, TITO A (DMD)
Entity Type:Individual
Prefix:DR
First Name:TITO
Middle Name:A
Last Name:GONZALEZ ANGELI
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 1:3508 VISTA TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-2508
Mailing Address - Country:US
Mailing Address - Phone:787-908-2230
Mailing Address - Fax:
Practice Address - Street 1:1354 W 43RD ST STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-4206
Practice Address - Country:US
Practice Address - Phone:713-263-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324391223G0001X
TX324291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice