Provider Demographics
NPI:1063623247
Name:GOMES, JOHN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GOMES
Suffix:JR
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 1:70 E GROVE ST # 656
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1810
Mailing Address - Country:US
Mailing Address - Phone:508-947-4770
Mailing Address - Fax:508-946-6040
Practice Address - Street 1:70 E GROVE ST # 656
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1810
Practice Address - Country:US
Practice Address - Phone:508-947-4770
Practice Address - Fax:508-946-6040
Is Sole Proprietor?:No
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice