Healthcare Provider Details

I. General information

NPI: 1285855171
Provider Name (Legal Business Name): GAYLA GOMOLYAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24112 E ORCHARD RD BLDG LF-09, UNIT E
AURORA CO
80016-5349
US

IV. Provider business mailing address

24112 E ORCHARD RD BLDG LF-09, UNIT E
AURORA CO
80016-5349
US

V. Phone/Fax

Practice location:
  • Phone: 303-457-5288
  • Fax:
Mailing address:
  • Phone: 303-457-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number904804
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: