Provider Demographics
NPI:1437378528
Name:GOMES, VICTOR M (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:GOMES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 ROEMER AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2257
Mailing Address - Country:US
Mailing Address - Phone:201-836-0342
Mailing Address - Fax:
Practice Address - Street 1:30 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1438
Practice Address - Country:US
Practice Address - Phone:973-589-0177
Practice Address - Fax:973-589-0177
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI17895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist