Provider Demographics
NPI:1760092423
Name:GONZALEZ, JESSE JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:JAMES
Last Name:GONZALEZ
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 1:23372 EL CAMPO RD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-4052
Mailing Address - Country:US
Mailing Address - Phone:956-490-6275
Mailing Address - Fax:
Practice Address - Street 1:2401 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1513
Practice Address - Country:US
Practice Address - Phone:806-358-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice