Provider Demographics
NPI:1205181146
Name:SASSE, ELIZABETH CATHERINE GOMEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CATHERINE GOMEZ
Last Name:SASSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 WILLAGILLESPIE RD
Mailing Address - Street 2:STE 250
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6798
Mailing Address - Country:US
Mailing Address - Phone:541-683-8396
Mailing Address - Fax:
Practice Address - Street 1:1045 WILLAGILLESPIE RD
Practice Address - Street 2:STE 250
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6798
Practice Address - Country:US
Practice Address - Phone:541-683-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089311223G0001X
ORD9874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice