Individual
JERRY P GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
223 16TH AVE N, NAMPA, ID 83687-4058
(208) 466-0515
(208) 466-5359
Mailing address
PO BOX 9, NAMPA, ID 83653-0009
(208) 466-0515
(208) 466-5359
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3729
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS10183
BOARD OF PHARMACY
ID
Enumeration date
08/18/2006
Last updated
03/07/2023
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