Provider Demographics
NPI:1942358007
Name:GOMES, DANIEL (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:GOMES
Suffix:
Gender:M
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 1:8235 COUNTRY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214
Mailing Address - Country:US
Mailing Address - Phone:317-299-4731
Mailing Address - Fax:317-329-5054
Practice Address - Street 1:8235 COUNTRY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214
Practice Address - Country:US
Practice Address - Phone:317-299-4731
Practice Address - Fax:317-329-5054
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010704-A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics