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General NPI Number Information
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NPI Number | 1346647393
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Entity Type | Organization
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Legal Business Name | DEMETRIO M GONZALEZ DDS PLLC
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 5622 EVERHART RD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-4905
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Country | US
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Telephone | 361-658-9927
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Fax |
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Provider Business Mailing Address
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Address Line | 5622 EVERHART RD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-4905
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Country | US
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Telephone | 361-658-9927
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DEMETRIO M GONZALEZ
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Credential |
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Telephone | 361-658-9927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 26521
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License Number State | TX
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