Healthcare Provider Details

I. General information

NPI: 1871768978
Provider Name (Legal Business Name): FRANKIE MIGUEL GOMEZ DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MILLS AVE STE 100
ORLANDO FL
32803-7103
US

IV. Provider business mailing address

610 N MILLS AVE STE 100
ORLANDO FL
32803-7103
US

V. Phone/Fax

Practice location:
  • Phone: 407-843-2261
  • Fax:
Mailing address:
  • Phone: 407-843-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5685
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN17113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: