Provider Demographics
NPI:1710192976
Name:GOMEZ, PATRICIA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 RAVENSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-256-5870
Mailing Address - Fax:703-256-5396
Practice Address - Street 1:4322 RAVENSWORTH RD.
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5630
Practice Address - Country:US
Practice Address - Phone:703-256-5870
Practice Address - Fax:703-256-5396
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014113721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice