Provider Demographics
NPI:1205095551
Name:GOMEZ, JUAN ARNALDO OQUENDO (DDS)
Entity type:Individual
Prefix:
First Name:JUAN ARNALDO
Middle Name:OQUENDO
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 1:3037 S DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7144
Mailing Address - Country:US
Mailing Address - Phone:702-253-5359
Mailing Address - Fax:702-253-6841
Practice Address - Street 1:3037 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7144
Practice Address - Country:US
Practice Address - Phone:702-253-5359
Practice Address - Fax:702-253-6841
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23661223G0001X
CA337691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice