Provider Demographics
NPI:1902275951
Name:GONZALEZ, DAVID ALFONSO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALFONSO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1921
Mailing Address - Country:US
Mailing Address - Phone:956-683-8880
Mailing Address - Fax:956-683-8883
Practice Address - Street 1:3118 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1921
Practice Address - Country:US
Practice Address - Phone:956-683-8880
Practice Address - Fax:956-683-8883
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090332003Medicaid