Erick Fernando Gomez Marroquin

Primary specialty

DentistTaxonomy code 122300000X

License

DF11888 Issued in MA

Practice address

One Kneeland St
Room 416
Boston, MA 02111

Phone

(617) 636-6814

NPI assigned

Jul 11, 2016

Reactivated

Nov 15, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1487006649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 CAMBRIDGE STREET",
            "address_2": "APARTMENT 2211",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "02129",
            "telephone_number": "860-515-9228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE KNEELAND ST",
            "address_2": "ROOM 416",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02111",
            "telephone_number": "617-636-6814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ MARROQUIN",
        "first_name": "ERICK",
        "middle_name": "FERNANDO",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-11",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "deactivation_date": "2021-10-22",
        "reactivation_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DF11773",
            "primary": false
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "FL",
            "license": "DN23854",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DF11888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Lee Gomes, MSW, LICSW
• Jennifer Lee Gomes, RN
• Lillian Gomes
• Lindsay Elizabeth Gomes
• Sole Gomes
• Jorge Luis Gomez Mayorga, MD
• Sara Isabel Gomez Villegas, MD
• Teresa Gomez-Isla, MD
• Andrea Del Pilar Gomez-Morad, MD
• Justin Lorenz Gomez-Stafford, MS

• Dentist in Boston, MA
• Providers in Boston, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.