Provider Demographics
NPI:1134310386
Name:GOMES, MARLY J (DMD)
Entity Type:Individual
Prefix:
First Name:MARLY
Middle Name:J
Last Name:GOMES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 STATE ROAD
Mailing Address - Street 2:SUITE 101 NAUSET BLDG
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-999-2334
Mailing Address - Fax:508-999-1155
Practice Address - Street 1:49 STATE ROAD
Practice Address - Street 2:SUITE 101 NAUSET BLDG
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747
Practice Address - Country:US
Practice Address - Phone:508-999-2334
Practice Address - Fax:508-999-1155
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist