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General NPI Number Information
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NPI Number | 1831243377
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Entity Type | Organization
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Legal Business Name | ELEANOR SA GOMEZ DMD PC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8039 LINCOLN AVE
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City | SKOKIE
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State | IL
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Zip | 60077-3612
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Country | US
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Telephone | 847-568-0834
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Fax | 847-568-9143
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Provider Business Mailing Address
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Address Line | 8039 LINCOLN AVE
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City | SKOKIE
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State | IL
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Zip | 60077-3612
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Country | US
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Telephone | 847-568-0834
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Fax | 847-568-9143
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ELEANOR SA GOMEZ
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Credential | DMD
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Telephone | 847-568-0834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | IL
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