Healthcare Provider Details

I. General information

NPI: 1699204941
Provider Name (Legal Business Name): CHRISTINA LOUISE GORY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 GATEWAY BLVD W STE 304
EL PASO TX
79925-2203
US

IV. Provider business mailing address

10175 GATEWAY BLVD W STE 304
EL PASO TX
79925-2203
US

V. Phone/Fax

Practice location:
  • Phone: 915-504-6880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number41270
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: