Basic Information
| Provider Information | |||||||||
| NPI: | 1629465513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ ANGELI | ||||||||
| FirstName: | TITO | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3508 VISTA TERRACE LN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770182508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879082230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1354 W 43RD ST STE C | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770184206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132637913 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2015 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 32439 | TX | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 32429 | TX | N | Dental Providers | Dentist | General Practice |
No ID Information.