Provider Demographics
NPI:1881167567
Name:DENTAL GEMS P.C.
Entity type:Organization
Organization Name:DENTAL GEMS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMENECH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-366-6791
Mailing Address - Street 1:20 CARL RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1106
Mailing Address - Country:US
Mailing Address - Phone:617-366-6791
Mailing Address - Fax:
Practice Address - Street 1:156 HARTFORD AVE UNIT D
Practice Address - Street 2:
Practice Address - City:HOPEDALE
Practice Address - State:MA
Practice Address - Zip Code:01747-1554
Practice Address - Country:US
Practice Address - Phone:617-366-6791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental