Provider Demographics
NPI:1457587297
Name:GOMENYUK, NINA (DDS)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:GOMENYUK
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 1:530 E BROMLEY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3298
Mailing Address - Country:US
Mailing Address - Phone:303-637-9047
Mailing Address - Fax:303-637-9046
Practice Address - Street 1:530 E BROMLEY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3298
Practice Address - Country:US
Practice Address - Phone:303-637-9047
Practice Address - Fax:303-637-9046
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice