Active NPI
Enio Gomez, RDH
- Dental Hygienist
- New Haven, CT
National Provider Identifier
1720535545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 7865
- Practice address
- 428 Columbus Ave
New Haven, CT 06519-1233 - Phone
- (203) 503-3040
- Fax
- (203) 503-3187
- NPI assigned
- Sep 9, 2016
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 7865 | CT | Primary |
Addresses
Primary practice location
428 Columbus Ave
New Haven, CT 06519-1233
Mailing address
400 Columbus Ave
New Haven, CT 06519-1233
Phone (203) 503-3174
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004235893 | Medicaid | CT |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7865 | CT | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475798400000",
"number": "1720535545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 COLUMBUS AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191233",
"telephone_number": "203-503-3174",
"fax_number": "203-503-3183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "428 COLUMBUS AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191233",
"telephone_number": "203-503-3040",
"fax_number": "203-503-3187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMEZ",
"first_name": "ENIO",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-09",
"last_updated": "2016-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CT",
"license": "7865",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004235893",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.