Provider Demographics
NPI:1366599730
Name:GONZALES, DAVID LLOYD SR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LLOYD
Last Name:GONZALES
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 HOUSTON BLVD
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:SOUTH HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-4517
Mailing Address - Country:US
Mailing Address - Phone:713-947-8510
Mailing Address - Fax:713-947-3218
Practice Address - Street 1:1712 HOUSTON BLVD
Practice Address - Street 2:SUITE # 2
Practice Address - City:SOUTH HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77587-4517
Practice Address - Country:US
Practice Address - Phone:713-947-8510
Practice Address - Fax:713-947-3218
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice