Individual
BIANCA GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
BLDG 9900 LINCOLN STREET, JBLM, WA 98431
(253) 968-4079
Mailing address
BLDG 9900 LINCOLN STREET, JBLM, WA 98431
(253) 968-4079
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
D160036350
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1182770279
DOD
—
Enumeration date
10/19/2017
Last updated
10/19/2017
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