Provider Demographics
NPI:1467715706
Name:GOMBAR, ANNA (DMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GOMBAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21921 TOWN PLACE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3714
Mailing Address - Country:US
Mailing Address - Phone:267-241-5473
Mailing Address - Fax:
Practice Address - Street 1:9121 N MILITARY TRL STE 209
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5988
Practice Address - Country:US
Practice Address - Phone:561-694-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391141223G0001X
FLDN21549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice