Provider Demographics
NPI:1447804232
Name:TERESA GAMEZ
Entity Type:Organization
Organization Name:TERESA GAMEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:686-333-0301
Mailing Address - Street 1:308 E 3RD ST. PMB 41021
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231
Mailing Address - Country:US
Mailing Address - Phone:686-333-0301
Mailing Address - Fax:858-430-3143
Practice Address - Street 1:AV. JORGE LOPEZ COLLADA#2095, FOVISTE
Practice Address - Street 2:
Practice Address - City:MEXICALI
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21038
Practice Address - Country:MX
Practice Address - Phone:686-333-0301
Practice Address - Fax:858-430-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty