Provider Demographics
NPI:1811409832
Name:SADER VERDE, GONZALO JOSE (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:JOSE
Last Name:SADER VERDE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 THORPE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-1629
Mailing Address - Country:US
Mailing Address - Phone:281-256-8400
Mailing Address - Fax:
Practice Address - Street 1:26321 NORTHWEST FWY STE 700
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5759
Practice Address - Country:US
Practice Address - Phone:281-256-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI182561223S0112X
TX348841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1811409832Medicaid