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NPI Code Detail

MEDICARE: MARTIN GONZALEZ DDS

MEDICARE:   MARTIN  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
11223G0001XGeneral Practice Dentistry25410TX

General Provider Information

NPI Number : 1356660724
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTIN GONZALEZ DDS
Provider Business Mailing Address
First Line : 7301 STATE HIGHWAY 161
Second Line : SUITE 198
City : IRVING
State : TX
Zip : 75039-2816
Country : US
Telephone Number : 972-869-3789
Fax Number :
Provider Business Practice Location Address
First Line : 2401 S STEMMONS FWY
Second Line : #1258
City : LEWISVILLE
State : TX
Zip : 75067-8775
Country : US
Telephone Number : 214-221-4867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2010
Last Update Date : 05/25/2010

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Directions to “ MARTIN GONZALEZ DDS” Practice Location

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