Provider Demographics
NPI:1871974063
Name:GONZALEZ, CHRISTINA CECILIA (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:CECILIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8056 SHIN OAK DR.
Mailing Address - Street 2:STE 100
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233
Mailing Address - Country:US
Mailing Address - Phone:210-658-3131
Mailing Address - Fax:210-658-9033
Practice Address - Street 1:8056 SHIN OAK DR.
Practice Address - Street 2:STE 100
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233
Practice Address - Country:US
Practice Address - Phone:210-658-3131
Practice Address - Fax:210-658-9033
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice