Provider Demographics
NPI:1821012162
Name:GONZALEZ, JOSE MANUEL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:GONZALEZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6801 MCPHERSON RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6402
Mailing Address - Country:US
Mailing Address - Phone:956-726-9975
Mailing Address - Fax:956-726-9979
Practice Address - Street 1:6801 MCPHERSON RD
Practice Address - Street 2:SUITE 225
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6402
Practice Address - Country:US
Practice Address - Phone:956-726-9975
Practice Address - Fax:956-726-9979
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX147591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice