Healthcare Provider Details

I. General information

NPI: 1376836742
Provider Name (Legal Business Name): NORMA GOMEZ DDS AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N MAIN ST STE 8
BRANFORD CT
06405-3044
US

IV. Provider business mailing address

144 N MAIN ST STE 8
BRANFORD CT
06405-3044
US

V. Phone/Fax

Practice location:
  • Phone: 203-481-0338
  • Fax: 203-481-0339
Mailing address:
  • Phone: 203-481-0338
  • Fax: 203-481-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9256
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9256
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number010722
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9256
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number261QD0000X
License Number StateCT

VIII. Authorized Official

Name: MRS. LINA VELEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 203-481-0338