Bianca Gomez – Dental Assistant in JBLM, WA

Key facts

NPI: 1801307681
Entity type: Individual (NPI type 1)
Primary specialty: Dental Assistant 126800000X
License: D160036350 (WA)
Practice address: BLDG 9900 Lincoln Street
JBLM, WA 98431
Phone: (253) 968-4079
NPI assigned: Oct 19, 2017
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
D160036350	WA	MD	Dental Assistant

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dental Assistant	126800000X	D160036350	WA	Yes

Addresses

Primary practice location

BLDG 9900 Lincoln Street
JBLM, WA 98431

Mailing address

BLDG 9900 Lincoln Street
JBLM, WA 98431
Phone (253) 968-4079

Other identifiers

Identifier	Type	State	Issuer
1182770279	Other		DOD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 19, 2017.

{
    "created_epoch": "1508371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508371200000",
    "number": "1801307681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLDG 9900 LINCOLN STREET",
            "city": "JBLM",
            "state": "WA",
            "postal_code": "98431",
            "telephone_number": "253-968-4079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 9900 LINCOLN STREET",
            "city": "JBLM",
            "state": "WA",
            "postal_code": "98431",
            "telephone_number": "253-968-4079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ",
        "first_name": "BIANCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-19",
        "last_updated": "2017-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "WA",
            "license": "D160036350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOD",
            "identifier": "1182770279",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in JBLM, WA

All providers in JBLM, WA · Dental Assistant in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2017. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.