Provider Demographics
NPI:1285875914
Name:GONZALEZ ZAMORA, JOSE M (DDS, ORAL REHAB)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:GONZALEZ ZAMORA
Suffix:
Gender:M
Credentials:DDS, ORAL REHAB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 GATEWAY BLVD W SPC 607
Mailing Address - Street 2:PMB 287
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3416
Mailing Address - Country:US
Mailing Address - Phone:915-239-2848
Mailing Address - Fax:
Practice Address - Street 1:PASEO DE LA VICTORIA 2975-D
Practice Address - Street 2:
Practice Address - City:JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32537
Practice Address - Country:MX
Practice Address - Phone:915-239-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ46588031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice