Provider Demographics
NPI:1376740381
Name:GOMEZ, GRISELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRISELL
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 W FLAGLER ST
Mailing Address - Street 2:SUITE A102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2054
Mailing Address - Country:US
Mailing Address - Phone:305-266-0341
Mailing Address - Fax:305-223-1797
Practice Address - Street 1:8500 W FLAGLER ST
Practice Address - Street 2:SUITE A102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2054
Practice Address - Country:US
Practice Address - Phone:305-266-0341
Practice Address - Fax:305-223-1797
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN115991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice