Provider Demographics
NPI:1639279334
Name:GUM, NANCY LYNN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYNN
Last Name:GUM
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 ROSS AVENUE
Mailing Address - Street 2:SUITE #305
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-269-3436
Mailing Address - Fax:408-269-3466
Practice Address - Street 1:3535 ROSS AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3054
Practice Address - Country:US
Practice Address - Phone:408-269-3436
Practice Address - Fax:408-269-3466
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-11-20
Deactivation Date:2023-07-25
Deactivation Code:
Reactivation Date:2023-11-20
Provider Licenses
StateLicense IDTaxonomies
CA347071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics