Healthcare Provider Details

I. General information

NPI: 1588550594
Provider Name (Legal Business Name): DEVIN SIMONE GOMEZ MPH, BSDH, RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 E STILL CIR
MESA AZ
85206-3618
US

IV. Provider business mailing address

1695 E HEATHER DR
SAN TAN VALLEY AZ
85140-5682
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-6000
  • Fax:
Mailing address:
  • Phone: 909-201-6048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH-4314
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH009379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: