Provider Demographics
NPI:1851603773
Name:GONZALEZ, SELSABEEL ADHAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:SELSABEEL
Middle Name:ADHAM
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 JONES MALTSBERGER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6920
Mailing Address - Country:US
Mailing Address - Phone:210-804-1558
Mailing Address - Fax:
Practice Address - Street 1:7902 JONES MALTSBERGER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6920
Practice Address - Country:US
Practice Address - Phone:210-804-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10980122300000X
TX26370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist