Provider Demographics
NPI:1427004456
Name:GOMEZ, SORAYA (DMD)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SORAYA
Other - Middle Name:
Other - Last Name:GREER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4332
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1835
Practice Address - Country:US
Practice Address - Phone:937-667-1122
Practice Address - Fax:419-225-8878
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300218901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2703882Medicaid