Provider Demographics
NPI:1063205169
Name:GOMEZ, VANESSA (DDS)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:X
Credentials:DDS
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9635 WOODMAN AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6470
Mailing Address - Country:US
Mailing Address - Phone:956-560-6361
Mailing Address - Fax:
Practice Address - Street 1:11850 1/2 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-2700
Practice Address - Country:US
Practice Address - Phone:818-360-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist