Provider Demographics
NPI:1164189882
Name:GM DENTAL PLLC
Entity Type:Organization
Organization Name:GM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GUILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:240-342-9215
Mailing Address - Street 1:10 FISHER ST APT 3204
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 STATE RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-4313
Practice Address - Country:US
Practice Address - Phone:774-770-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental