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General NPI Number Information
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NPI Number | 1326163114
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Entity Type | Individual
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Provider Name | SANDRA P. GOMEZ D.D.S
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 1740 E COMMERCIAL BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334
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Country | US
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Telephone | 954-958-3584
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Fax | 954-958-3585
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Provider Business Mailing Address
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Address Line | 2829 N.E 33RD COURT #405
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306
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Country | US
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Telephone | 954-564-5725
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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 | DN 16504
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License Number State | FL
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