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General NPI Number Information
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NPI Number | 1265091185
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Entity Type | Individual
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Provider Name | DALLIN GOMEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 2200 GRANDE BLVD SE STE A
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City | RIO RANCHO
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State | NM
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Zip | 87124-1695
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Country | US
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Telephone | 505-891-1500
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Fax | 972-590-8809
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Provider Business Mailing Address
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Address Line | 7496 FOOTHILL DR
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City | LAKE POINT
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State | UT
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Zip | 84074-8925
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Country | US
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Telephone | 801-472-3105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11297718-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD5116
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License Number State | NM
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