Provider Demographics
NPI:1053437814
Name:GONZALES, MANUEL SYLVESTER (DDS)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:SYLVESTER
Last Name:GONZALES
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 1:4010 SANDY BROOK
Mailing Address - Street 2:STE 104
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665
Mailing Address - Country:US
Mailing Address - Phone:512-501-4020
Mailing Address - Fax:512-501-4021
Practice Address - Street 1:4010 SANDY BROOK
Practice Address - Street 2:STE 104
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665
Practice Address - Country:US
Practice Address - Phone:512-501-4020
Practice Address - Fax:512-501-4021
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223111223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice