Provider Demographics
NPI:1073619953
Name:GOMEZ, DIANA P (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:P
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 COMMODITY CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9053
Mailing Address - Country:US
Mailing Address - Phone:407-248-0100
Mailing Address - Fax:407-248-8364
Practice Address - Street 1:8801 COMMODITY CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9053
Practice Address - Country:US
Practice Address - Phone:407-248-0100
Practice Address - Fax:407-248-8364
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL142381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
970832OtherUNITED CONCORDIA
FL64876OtherBCBS