Provider Demographics
NPI:1033571401
Name:OFICINA DENTAL DR GOMEZ, C.S.P.
Entity Type:Organization
Organization Name:OFICINA DENTAL DR GOMEZ, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-731-2790
Mailing Address - Street 1:HC 1 BOX 29030
Mailing Address - Street 2:DPT 523
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8900
Mailing Address - Country:US
Mailing Address - Phone:787-731-2103
Mailing Address - Fax:
Practice Address - Street 1:CARR. 173 KM 8.4
Practice Address - Street 2:BARRIO RIOS
Practice Address - City:GUYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-731-2790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty