Provider Demographics
NPI:1700222833
Name:MARY JOYCE GOMEZ, DDS, P.C.
Entity Type:Organization
Organization Name:MARY JOYCE GOMEZ, DDS, P.C.
Other - Org Name:CHICAGO DOWNTOWN DENTAL SUITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY JOYCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-984-0032
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1821
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-984-0032
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1821
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-984-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029129261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental