Provider Demographics
NPI:1306144480
Name:BRAUNTHAL, GONZALO FRANCISCO (DMD)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:FRANCISCO
Last Name:BRAUNTHAL
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 1:7097 N EXPRESSWAY 77 STE 10
Mailing Address - Street 2:
Mailing Address - City:OLMITO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9808
Mailing Address - Country:US
Mailing Address - Phone:956-621-1440
Mailing Address - Fax:956-621-1441
Practice Address - Street 1:7097 N EXPRESSWAY 77 STE 10
Practice Address - Street 2:
Practice Address - City:OLMITO
Practice Address - State:TX
Practice Address - Zip Code:78575-9808
Practice Address - Country:US
Practice Address - Phone:956-621-1440
Practice Address - Fax:956-621-1441
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice