Healthcare Provider Details

I. General information

NPI: 1275631491
Provider Name (Legal Business Name): NANCY L. GUM DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 WILLOW STREET SUITE K
SAN JOSE CA
95125
US

IV. Provider business mailing address

1688 WILLOW ST SUITE K
SAN JOSE CA
95125
US

V. Phone/Fax

Practice location:
  • Phone: 408-269-3436
  • Fax: 408-269-3466
Mailing address:
  • Phone: 408-269-3436
  • Fax: 408-269-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number34707
License Number StateCA

VIII. Authorized Official

Name: DR. NANCY L GUM
Title or Position: ORTHODONTIST/PRACTICE OWNER
Credential: D.D.S., M.S.D.
Phone: 408-269-3436