Provider Demographics
NPI:1003065095
Name:GOMES DENTAL, PC
Entity Type:Organization
Organization Name:GOMES DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-788-1967
Mailing Address - Street 1:4115 POND HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231
Mailing Address - Country:US
Mailing Address - Phone:210-788-1967
Mailing Address - Fax:
Practice Address - Street 1:4115 POND HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231
Practice Address - Country:US
Practice Address - Phone:210-788-1967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty