Provider Demographics
NPI:1104907393
Name:GOMEZ, HANETTE SABINA (DDS)
Entity type:Individual
Prefix:MRS
First Name:HANETTE
Middle Name:SABINA
Last Name:GOMEZ
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 1:9605 40TH ROAD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:718-651-7070
Mailing Address - Fax:718-651-6559
Practice Address - Street 1:9605 40TH ROAD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-651-7070
Practice Address - Fax:718-651-6559
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist