Provider Demographics
NPI:1891995148
Name:GONZALEZ, JOSE FERNANDO (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FERNANDO
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 1:9090 SKILLMAN ST
Mailing Address - Street 2:STE 200C
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8259
Mailing Address - Country:US
Mailing Address - Phone:214-342-5757
Mailing Address - Fax:214-340-4868
Practice Address - Street 1:817 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4924
Practice Address - Country:US
Practice Address - Phone:214-941-5777
Practice Address - Fax:214-941-5131
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice