Provider Demographics
NPI:1376131052
Name:HANETTE GOMEZ DENTISTRY PLLC
Entity Type:Organization
Organization Name:HANETTE GOMEZ DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HANETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-848-7878
Mailing Address - Street 1:9531 156TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2863
Mailing Address - Country:US
Mailing Address - Phone:718-848-7878
Mailing Address - Fax:718-848-4374
Practice Address - Street 1:9531 156TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2863
Practice Address - Country:US
Practice Address - Phone:718-848-7878
Practice Address - Fax:718-848-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01281218Medicaid