Provider Demographics
NPI:1164541843
Name:GOMEZ, MARIA CYNTHIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CYNTHIA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:R
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:133 E 58TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1236
Mailing Address - Country:US
Mailing Address - Phone:212-207-4020
Mailing Address - Fax:212-207-4023
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:212-207-4020
Practice Address - Fax:212-207-4023
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0424531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics