Active NPI
Eugene Justin Gomes III, DDS
- Dentist
- Maplewood, MN
National Provider Identifier
1063521680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D 11118
- Practice address
- 1866 Beam Avenue
Maplewood, MN 55109 - Phone
- (651) 774-7144
- Fax
- (651) 770-0560
- NPI assigned
- Aug 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D 11118 | MN | Primary |
Addresses
Primary practice location
1866 Beam Avenue
Maplewood, MN 55109
Mailing address
PO Box 23029
Richfield, MN 55423
Phone (612) 861-9123
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D 11118 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metro Dentalcare, PLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Lakeville, MN
- NPI 1316913411
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063521680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 23029",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "55423",
"telephone_number": "612-861-9123",
"fax_number": "612-861-9155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1866 BEAM AVENUE",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "55109",
"telephone_number": "651-774-7144",
"fax_number": "651-770-0560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMES",
"first_name": "EUGENE",
"middle_name": "JUSTIN",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D 11118",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.