Provider Demographics
NPI:1871768978
Name:GOMEZ, FRANKIE MIGUEL (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:FRANKIE
Middle Name:MIGUEL
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MILLS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-7103
Mailing Address - Country:US
Mailing Address - Phone:407-843-2261
Mailing Address - Fax:
Practice Address - Street 1:610 N MILLS AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-7103
Practice Address - Country:US
Practice Address - Phone:407-843-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56851223S0112X
FLDN171131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery