Provider Demographics
NPI:1851040067
Name:GOMEZ, MARIANNA RUBY (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:RUBY
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 1:5982 SYCAMORE CANYON BLVD APT 1092
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0876
Mailing Address - Country:US
Mailing Address - Phone:714-552-7759
Mailing Address - Fax:
Practice Address - Street 1:701 N MILLIKEN AVE STE B
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5018
Practice Address - Country:US
Practice Address - Phone:909-294-8690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1098791223G0001X
TX384331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice