Provider Demographics
NPI:1720447105
Name:GOMEZ, NIURVIS (DDS)
Entity type:Individual
Prefix:
First Name:NIURVIS
Middle Name:
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 1:4236 SW 164TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5290
Mailing Address - Country:US
Mailing Address - Phone:786-442-7358
Mailing Address - Fax:
Practice Address - Street 1:2435 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3134
Practice Address - Country:US
Practice Address - Phone:305-501-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program