Provider Demographics
NPI:1275631491
Name:NANCY L. GUM DDS, INC.
Entity Type:Organization
Organization Name:NANCY L. GUM DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:408-269-3436
Mailing Address - Street 1:3535 ROSS AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3054
Mailing Address - Country:US
Mailing Address - Phone:408-269-3436
Mailing Address - Fax:408-269-3466
Practice Address - Street 1:1688 WILLOW STREET
Practice Address - Street 2:SUITE K
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-269-3436
Practice Address - Fax:408-269-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty