Provider Demographics
NPI:1316537129
Name:GOMEZ, JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 ARAPAHOE RD UNIT 30
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6008
Mailing Address - Country:US
Mailing Address - Phone:850-748-2351
Mailing Address - Fax:
Practice Address - Street 1:3331 ARAPAHOE RD UNIT 30
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-6008
Practice Address - Country:US
Practice Address - Phone:850-748-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist