Provider Demographics
NPI:1467506881
Name:GONCALVES, ANTONIO MANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MANUEL
Last Name:GONCALVES
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 1:1345 ROCKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1932
Mailing Address - Country:US
Mailing Address - Phone:508-997-8544
Mailing Address - Fax:508-992-1114
Practice Address - Street 1:16 BRIDGE STREET
Practice Address - Street 2:CORLISS LANDING
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4362
Practice Address - Country:US
Practice Address - Phone:401-861-5600
Practice Address - Fax:401-861-5603
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI022741223G0001X
MA164271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice