Provider Demographics
NPI:1124132162
Name:GONZALEZ, ROY R (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:R
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
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Mailing Address - Street 1:1100 NW LOOP 410
Mailing Address - Street 2:SUITE 560
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213
Mailing Address - Country:US
Mailing Address - Phone:210-344-9295
Mailing Address - Fax:210-979-0348
Practice Address - Street 1:1100 NW LOOP 410
Practice Address - Street 2:SUITE 560
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213
Practice Address - Country:US
Practice Address - Phone:210-344-9295
Practice Address - Fax:210-979-0348
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX59061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics