Healthcare Provider Details

I. General information

NPI: 1902726102
Provider Name (Legal Business Name): CLEBER JANUARIO GOMES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 PACIFIC AVE STE 250
LONG BEACH CA
90806-2663
US

IV. Provider business mailing address

1112 LOCUST AVE APT 511
LONG BEACH CA
90813-3446
US

V. Phone/Fax

Practice location:
  • Phone: 310-936-6517
  • Fax: 562-317-5260
Mailing address:
  • Phone: 310-936-6517
  • Fax: 562-317-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number036862
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: