Provider Demographics
NPI:1285855171
Name:GOMOLYAKA, GAYLA
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:
Last Name:GOMOLYAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24112 E ORCHARD RD
Mailing Address - Street 2:BLDG LF-09, UNIT E
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5349
Mailing Address - Country:US
Mailing Address - Phone:303-457-5288
Mailing Address - Fax:
Practice Address - Street 1:24112 E ORCHARD RD
Practice Address - Street 2:BLDG LF-09, UNIT E
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5349
Practice Address - Country:US
Practice Address - Phone:303-457-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904804124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist