MEDICARE: DR. SCOTT JOSEPH GOMEZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DT-1377	HI

General Provider Information

NPI Number	:	1215944178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT JOSEPH GOMEZ D.D.S.

Provider Business Mailing Address
First Line	:	98-1268 KAAHUMANU ST.
Second Line	:	STE. #2C-3
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3257
Country	:	US
Telephone Number	:	808-486-4746
Fax Number	:	808-487-9134

Provider Business Practice Location Address
First Line	:	98-1268 KAAHUMANU ST.
Second Line	:	STE. #2C-3
City	:	PEARL CITY
State	:	HI
Zip	:	96782-3257
Country	:	US
Telephone Number	:	808-486-4746
Fax Number	:	808-487-9134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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