Healthcare Provider Details

I. General information

NPI: 1942001995
Provider Name (Legal Business Name): GOMEZ MAXILLOFACIAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N LAKEMONT AVE STE 2200
WINTER PARK FL
32792-3208
US

IV. Provider business mailing address

201 N LAKEMONT AVE STE 2200
WINTER PARK FL
32792-3208
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-0075
  • Fax: 407-629-0027
Mailing address:
  • Phone: 407-629-0075
  • Fax: 407-629-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: FRANKIE GOMEZ
Title or Position: OWNER/CEO
Credential: DMD
Phone: 407-629-0075