Provider Demographics
NPI:1689899452
Name:GOMEZ, LUIS FERNANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FERNANDO
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 N STATE ROAD 7 STE 4
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4378
Mailing Address - Country:US
Mailing Address - Phone:954-510-4300
Mailing Address - Fax:954-510-4303
Practice Address - Street 1:4651 N STATE ROAD 7 STE 4
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4378
Practice Address - Country:US
Practice Address - Phone:954-510-4300
Practice Address - Fax:954-510-4303
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN148561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice