Provider Demographics
NPI:1538787601
Name:GOMEZ, ELIZABETH FRANCES (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:FRANCES
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75728
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-1033
Mailing Address - Country:US
Mailing Address - Phone:305-632-2435
Mailing Address - Fax:
Practice Address - Street 1:3719 W ANTHEM WAY STE 101
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0477
Practice Address - Country:US
Practice Address - Phone:623-233-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist