Provider Demographics
NPI:1033320544
Name:CUMBA-GONZALEZ, IVETTE M (DMD)
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:M
Last Name:CUMBA-GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1620 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78416-1353
Mailing Address - Country:US
Mailing Address - Phone:361-853-7156
Mailing Address - Fax:361-853-7127
Practice Address - Street 1:1620 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 250
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78416-1353
Practice Address - Country:US
Practice Address - Phone:361-853-7156
Practice Address - Fax:361-853-7127
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX262051223G0001X
PR20641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice