Provider Demographics
NPI:1902066335
Name:GOMEZ-BARTEK, JACQUELYN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:M
Last Name:GOMEZ-BARTEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 AVENIDA RINCON UNIT 105
Mailing Address - Street 2:SANTA FE
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-6009
Mailing Address - Country:US
Mailing Address - Phone:505-310-3603
Mailing Address - Fax:
Practice Address - Street 1:550B SAINT MICHAELS DR STE 2
Practice Address - Street 2:SANTA FE
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7604
Practice Address - Country:US
Practice Address - Phone:505-471-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist