1932751062 NPI number — GOMEZ DENTAL SOLUTIONS LLC

Table of content: (NPI 1932751062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932751062 NPI number — GOMEZ DENTAL SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOMEZ DENTAL SOLUTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOMEZ DENTAL FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932751062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 NORMANDY ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77015-4952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-453-9926
Provider Business Mailing Address Fax Number:
713-453-9927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 NORMANDY ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77015-4952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-453-9926
Provider Business Practice Location Address Fax Number:
713-453-9927
Provider Enumeration Date:
07/09/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
OWNER/GENERAL DENTIST
Authorized Official Telephone Number:
713-553-9171

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25658 . This is a "TSBDE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".