Provider Demographics
NPI:1235553009
Name:GOMEZ, ANNE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:L
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 GREVE AVE
Mailing Address - Street 2:APT F
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-2354
Mailing Address - Country:US
Mailing Address - Phone:917-363-2967
Mailing Address - Fax:
Practice Address - Street 1:1913 GREVE AVE
Practice Address - Street 2:APT F
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-2354
Practice Address - Country:US
Practice Address - Phone:917-363-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025590001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice