Provider Demographics
NPI:1841375615
Name:GONZALES, CARA BRIGHAM (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:CARA
Middle Name:BRIGHAM
Last Name:GONZALES
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6822 SPRING ROSE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2945
Mailing Address - Country:US
Mailing Address - Phone:210-694-4549
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF TEXAS HSC DENTAL SCHOOL
Practice Address - Street 2:7703 FLOYD CURL DR.
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-567-3333
Practice Address - Fax:210-567-3334
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice