Provider Demographics
NPI:1659589679
Name:GOMEZ, CARLOS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LIZBETH LN
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1210
Mailing Address - Country:US
Mailing Address - Phone:484-678-5108
Mailing Address - Fax:
Practice Address - Street 1:3915 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-5502
Practice Address - Country:US
Practice Address - Phone:610-269-1900
Practice Address - Fax:610-269-2725
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0357911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry