Provider Demographics
NPI:1831243377
Name:ELEANOR SA GOMEZ DMD PC
Entity type:Organization
Organization Name:ELEANOR SA GOMEZ DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:SA
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-568-0834
Mailing Address - Street 1:8039 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3612
Mailing Address - Country:US
Mailing Address - Phone:847-568-0834
Mailing Address - Fax:847-568-9143
Practice Address - Street 1:8039 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3612
Practice Address - Country:US
Practice Address - Phone:847-568-0834
Practice Address - Fax:847-568-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty