Provider Demographics
NPI:1316922701
Name:GOMEZ, JOSE R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:R
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:HC 1 BOX 29030
Mailing Address - Street 2:DPT 523
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-8900
Mailing Address - Country:US
Mailing Address - Phone:787-731-2790
Mailing Address - Fax:787-272-2185
Practice Address - Street 1:CARRETERA 173 KM 8.9
Practice Address - Street 2:BARRIO RIOS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-731-2790
Practice Address - Fax:787-272-2185
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice