Provider Demographics
NPI:1235290404
Name:GOMEZ, ANGEL (D)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5010
Mailing Address - Country:US
Mailing Address - Phone:787-744-3236
Mailing Address - Fax:787-704-0445
Practice Address - Street 1:FF6 VILLA DEL REY CARR 172
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-3236
Practice Address - Fax:787-704-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice