Provider Demographics
NPI:1477282671
Name:GOMEZ HERNANDEZ, YOSDENIA
Entity Type:Individual
Prefix:
First Name:YOSDENIA
Middle Name:
Last Name:GOMEZ HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11696 NW 89TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4152
Mailing Address - Country:US
Mailing Address - Phone:786-405-5425
Mailing Address - Fax:
Practice Address - Street 1:11696 NW 89TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4152
Practice Address - Country:US
Practice Address - Phone:786-405-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist