MEDICARE: DR. FEDERICO GONZALEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	31121	TX
2	122300000X	Dentist	6284	OK

General Provider Information

NPI Number	:	1437447984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FEDERICO GONZALEZ DDS

Provider Business Mailing Address
First Line	:	8714 FREDERICKSBURG RD STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1224
Country	:	US
Telephone Number	:	210-910-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	8714 FREDERICKSBURG RD STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1224
Country	:	US
Telephone Number	:	210-910-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	12/12/2023

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