Provider Demographics
NPI:1487189296
Name:GOMEZ ALIE DDS
Entity Type:Organization
Organization Name:GOMEZ ALIE DDS
Other - Org Name:URBANA FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RIAAZ
Authorized Official - Middle Name:NAEEM
Authorized Official - Last Name:ALIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-810-2172
Mailing Address - Street 1:449 CLAYHALL ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-6501
Mailing Address - Country:US
Mailing Address - Phone:301-518-7772
Mailing Address - Fax:
Practice Address - Street 1:3370 URBANA PIKE
Practice Address - Street 2:
Practice Address - City:IJAMSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21754-9435
Practice Address - Country:US
Practice Address - Phone:301-810-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty