Healthcare Provider Details

I. General information

NPI: 1063702322
Provider Name (Legal Business Name): PABLO L GONZALEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 INDUSTRIAL ST
REDDING CA
96002-0757
US

IV. Provider business mailing address

1600 N SARAH DEWITT DR STE 206
GONZALES TX
78629-2714
US

V. Phone/Fax

Practice location:
  • Phone: 530-229-5000
  • Fax:
Mailing address:
  • Phone: 702-748-8244
  • Fax: 702-997-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number35903
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: