Provider Demographics
NPI:1730331794
Name:GONZALEZ, /ELEAZAR ANTONIO (DDS)
Entity type:Individual
Prefix:DR
First Name:/ELEAZAR
Middle Name:ANTONIO
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 1:3316 GREENOCK ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-4100
Mailing Address - Country:US
Mailing Address - Phone:915-613-4848
Mailing Address - Fax:915-875-1795
Practice Address - Street 1:BLVD. GOMEZ MORIN 1450
Practice Address - Street 2:COLONIA SATELITE
Practice Address - City:CIUDAD JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32540
Practice Address - Country:MX
Practice Address - Phone:656-682-1100
Practice Address - Fax:656-682-1100
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ23119171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice