Provider Demographics
NPI:1285872564
Name:GOMEZ, DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:4619 SAN DARIO AVE # 471
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5773
Mailing Address - Country:US
Mailing Address - Phone:956-624-7600
Mailing Address - Fax:
Practice Address - Street 1:HEROES DE NACATAZ 2401
Practice Address - Street 2:
Practice Address - City:NUEVO LAREDO
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88000
Practice Address - Country:MX
Practice Address - Phone:867-712-6961
Practice Address - Fax:867-712-6961
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ6871311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice