Provider Demographics
NPI:1295396216
Name:GONZALEZ, ADRIAN LEOBARDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:LEOBARDO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-3027
Mailing Address - Country:US
Mailing Address - Phone:617-389-0877
Mailing Address - Fax:
Practice Address - Street 1:826 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3027
Practice Address - Country:US
Practice Address - Phone:617-389-0877
Practice Address - Fax:617-389-0978
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist