Dallin Gomez, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD5116 Issued in NM

Practice address

2200 Grande Blvd SE Ste a
Rio Rancho, NM 87124-1695

Phone

(505) 891-1500

Fax

(972) 590-8809

NPI assigned

Jun 13, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Grande Dentistry LLC

  • General Practice Dentistry
  • Rio Rancho, NM
  • NPI 1972166262

  General Practice

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1265091185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7496 FOOTHILL DR",
            "city": "LAKE POINT",
            "state": "UT",
            "postal_code": "840748925",
            "telephone_number": "801-472-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 GRANDE BLVD SE STE A",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241695",
            "telephone_number": "505-891-1500",
            "fax_number": "972-590-8809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 E 840 S",
            "address_purpose": "LOCATION",
            "city": "Orem",
            "state": "UT",
            "postal_code": "840585018",
            "country_code": "US",
            "telephone_number": "801-375-9511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "DALLIN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-13",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "11297718-9922",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD5116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget Goldfarb, CFNP
• Stacey Goldstein-Dwyer, PSYD, MA
• Jonathan Forrest Goldstone, MD
• Jessica Goldtooth, PSR INSTRUCTOR
• Juan David Gomez Cifuentes, MD
• Gabriel Gomez, PHARM-D
• Kyle Gonterman
• Grace Gontis
• Alyssa Gonzales, PA
• Alyssa Nicole Gonzales, LCSW, SSW

• All providers in Rio Rancho, NM
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.