Provider Demographics
NPI:1881116804
Name:GONZALEZ, HEATHER LYNN (DDS)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 CLEARVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5925
Mailing Address - Country:US
Mailing Address - Phone:361-701-5564
Mailing Address - Fax:
Practice Address - Street 1:6334 FM 2920 RD STE 250
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3473
Practice Address - Country:US
Practice Address - Phone:281-655-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice