Provider Demographics
NPI:1740514421
Name:GOMEZ, JOSEPH ALVARO (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALVARO
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 1:575 MONROE TPKE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2310
Mailing Address - Country:US
Mailing Address - Phone:203-268-1593
Mailing Address - Fax:
Practice Address - Street 1:575 MONROE TPKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2310
Practice Address - Country:US
Practice Address - Phone:203-268-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist