Provider Demographics
NPI:1063702322
Name:GONZALEZ, PABLO L (DMD)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:L
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 1:1600 N SARAH DEWITT DR STE 206
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-2714
Mailing Address - Country:US
Mailing Address - Phone:702-748-8244
Mailing Address - Fax:702-997-1223
Practice Address - Street 1:1600 N SARAH DEWITT DR STE 206
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-2714
Practice Address - Country:US
Practice Address - Phone:026-267-0447
Practice Address - Fax:026-267-0447
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60042122300000X
TX35903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist