Provider Demographics
NPI:1215389051
Name:GOMEZ, JAIME RAFAEL II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:RAFAEL
Last Name:GOMEZ
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1778 S WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-1127
Mailing Address - Country:US
Mailing Address - Phone:830-626-1002
Mailing Address - Fax:
Practice Address - Street 1:1778 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-1127
Practice Address - Country:US
Practice Address - Phone:830-626-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice