MEDICARE: ROY GONZALEZ JR. D.D.S.,M.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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12834	TX

General Provider Information

NPI Number	:	1750504494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY GONZALEZ JR. D.D.S.,M.S.

Provider Business Mailing Address
First Line	:	1100 NW LOOP 410
Second Line	:	SUITE 560
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2263
Country	:	US
Telephone Number	:	210-344-9295
Fax Number	:	210-979-0348

Provider Business Practice Location Address
First Line	:	1100 NW LOOP 410
Second Line	:	SUITE 560
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2263
Country	:	US
Telephone Number	:	210-344-9295
Fax Number	:	210-979-0348

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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Directions to “ ROY GONZALEZ JR. D.D.S.,M.S.” Practice Location

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