Provider Demographics
NPI:1407409089
Name:CRODDY, DAVID ARMEL GOMEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID ARMEL
Middle Name:GOMEZ
Last Name:CRODDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:GOMEZ
Other - Last Name:CRODDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3700 PECOS MCLEOD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4259
Mailing Address - Country:US
Mailing Address - Phone:702-732-2333
Mailing Address - Fax:702-732-0881
Practice Address - Street 1:3700 PECOS MCLEOD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4257
Practice Address - Country:US
Practice Address - Phone:916-606-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104117122300000X
NV7331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist