Provider Demographics
NPI:1760605414
Name:ROY R. GONZALEZ,DDS,MSD,PA
Entity Type:Organization
Organization Name:ROY R. GONZALEZ,DDS,MSD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD
Authorized Official - Phone:210-344-9295
Mailing Address - Street 1:1100 NW LOOP 410
Mailing Address - Street 2:SUITE 560
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2263
Mailing Address - Country:US
Mailing Address - Phone:210-344-9295
Mailing Address - Fax:210-979-0348
Practice Address - Street 1:1100 NW LOOP 410
Practice Address - Street 2:SUITE 560
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2263
Practice Address - Country:US
Practice Address - Phone:210-344-9295
Practice Address - Fax:210-979-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty