Provider Demographics
NPI:1326224098
Name:GOMES, JUAN ANDRE (DDS)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANDRE
Last Name:GOMES
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 1:860 KUHN DR
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4517
Mailing Address - Country:US
Mailing Address - Phone:619-656-9393
Mailing Address - Fax:619-656-6464
Practice Address - Street 1:860 KUHN DR
Practice Address - Street 2:SUITE # 203
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4517
Practice Address - Country:US
Practice Address - Phone:619-656-9393
Practice Address - Fax:619-656-6464
Is Sole Proprietor?:No
Enumeration Date:2008-01-12
Last Update Date:2008-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458631223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics