MEDICARE: DR. DAVID LLOYD GONZALES SR. D.D.S.

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	13183	TX

General Provider Information

NPI Number	:	1366599730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LLOYD GONZALES SR. D.D.S.

Provider Business Mailing Address
First Line	:	1712 HOUSTON BLVD
Second Line	:	SUITE # 2
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-4517
Country	:	US
Telephone Number	:	713-947-8510
Fax Number	:	713-947-3218

Provider Business Practice Location Address
First Line	:	1712 HOUSTON BLVD
Second Line	:	SUITE # 2
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-4517
Country	:	US
Telephone Number	:	713-947-8510
Fax Number	:	713-947-3218

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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