MEDICARE: JUAN ARNALDO OQUENDO GOMEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2366	NV
2	1223G0001X	General Practice Dentistry	33769	CA

General Provider Information

NPI Number	:	1205095551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN ARNALDO OQUENDO GOMEZ DDS

Provider Business Mailing Address
First Line	:	3037 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-7144
Country	:	US
Telephone Number	:	702-253-5359
Fax Number	:	702-253-6841

Provider Business Practice Location Address
First Line	:	3037 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-7144
Country	:	US
Telephone Number	:	702-253-5359
Fax Number	:	702-253-6841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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