Gustavo Alberto Gonzalez-Nieto, D.D.S.
Individual provider Active NPI General Practice Dentistry · Teague, TX
NPI 1487811352 · NPPES record last updated Mar 7, 2016
Key facts
- NPI
- 1487811352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 23863 (TX)
- Practice address
- 109 N 4TH Ave
Teague, TX 75860-1601 - Phone
- (254) 739-2533
- Fax
- (254) 739-2534
- NPI assigned
- May 19, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231218003024 | TX | Order and Referring Only - Dentist |
9931499092 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23863 | TX | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gonzalez Dentistry, Inc | General Practice | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 23863 | TX | Yes |
Addresses
Primary practice location
109 N 4TH Ave
Teague, TX 75860-1601
Mailing address
109 N 4TH Ave
Teague, TX 75860-1601
Phone (254) 739-2533
Other providers in Teague, TX
- Dew Isd
- Burma Dugger
- Fairfield Hospital District
- Lauren Hirsch George
- Gonzalez Dentistry, Inc
- Veronica Harris
- Raechel Christeene Hataway
- JHS Operations, LLC
- Robin Louise Johnson
- Rebecca Korn
All providers in Teague, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.