Provider Demographics
NPI:1912002056
Name:GONZALEZ, ROEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROEL
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WONDER WORLD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7558
Mailing Address - Country:US
Mailing Address - Phone:512-353-5500
Mailing Address - Fax:512-353-1619
Practice Address - Street 1:1320 WONDER WORLD DR STE 103
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7558
Practice Address - Country:US
Practice Address - Phone:512-353-5500
Practice Address - Fax:512-353-1619
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty