Provider Demographics
NPI:1245391978
Name:GOMEZ, GUILLERMO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5225 KATY FWY STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2268
Mailing Address - Country:US
Mailing Address - Phone:832-673-0999
Mailing Address - Fax:281-657-2406
Practice Address - Street 1:7036 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-6613
Practice Address - Country:US
Practice Address - Phone:281-260-8999
Practice Address - Fax:281-260-8866
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice