Provider Demographics
NPI:1396976502
Name:GOMEZ, DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 S MASON RD SUITE B3
Mailing Address - Street 2:SUITE #B3
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6252
Mailing Address - Country:US
Mailing Address - Phone:832-222-0016
Mailing Address - Fax:832-559-0772
Practice Address - Street 1:2004 S MASON RD # B3
Practice Address - Street 2:SUITE B3
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6252
Practice Address - Country:US
Practice Address - Phone:832-222-0016
Practice Address - Fax:832-559-0772
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24804OtherTEXAS LICENSE