Provider Demographics
NPI:1164617445
Name:GOMEZ, JOSEPH G JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:GOMEZ
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W RIVER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-1435
Mailing Address - Country:US
Mailing Address - Phone:978-544-7965
Mailing Address - Fax:978-544-2922
Practice Address - Street 1:450 W RIVER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1435
Practice Address - Country:US
Practice Address - Phone:978-544-7965
Practice Address - Fax:978-544-2922
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist