MEDICARE: JONATHAN GOMOGDA

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	DN31712	FL

General Provider Information

NPI Number	:	1821832270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN GOMOGDA

Provider Business Mailing Address
First Line	:	11345 US HIGHWAY 301 S STE 104
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-6279
Country	:	US
Telephone Number	:	813-367-9496
Fax Number	:

Provider Business Practice Location Address
First Line	:	11345 US HIGHWAY 301 S STE 104
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-6279
Country	:	US
Telephone Number	:	813-367-9496
Fax Number	:

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

Provider Enumeration Date	:	06/20/2024
Last Update Date	:	06/01/2026

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Directions to “ JONATHAN GOMOGDA ” Practice Location

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