Provider Demographics
NPI:1215944178
Name:GOMEZ, SCOTT JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOSEPH
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1268 KAAHUMANU ST.
Mailing Address - Street 2:STE. #2C-3
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3257
Mailing Address - Country:US
Mailing Address - Phone:808-486-4746
Mailing Address - Fax:808-487-9134
Practice Address - Street 1:98-1268 KAAHUMANU ST.
Practice Address - Street 2:STE. #2C-3
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3257
Practice Address - Country:US
Practice Address - Phone:808-486-4746
Practice Address - Fax:808-487-9134
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-13771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice