Provider Demographics
NPI:1346649118
Name:GOMEZ PEREZ, NILS (DDS)
Entity Type:Individual
Prefix:
First Name:NILS
Middle Name:
Last Name:GOMEZ PEREZ
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 1:1031 NE 17TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4691
Mailing Address - Country:US
Mailing Address - Phone:786-352-5158
Mailing Address - Fax:
Practice Address - Street 1:1031 NE 17TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4691
Practice Address - Country:US
Practice Address - Phone:786-352-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 209031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice