Active NPI
Ilenia Elizabeth Gonzalez Gusmao
- Prosthodontics
- Salem, MA
National Provider Identifier
1083067870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- DN1859794
- Practice address
- 20 Central St Ste 111
Salem, MA 01970-3752 - Phone
- (617) 636-6591
- NPI assigned
- Jul 18, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | DN1859794 | MA | Primary |
Addresses
Primary practice location
20 Central St Ste 111
Salem, MA 01970-3752
Mailing address
228 W Shore Dr
Marblehead, MA 01945-1322
Phone (202) 802-7337
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859794 | MA | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692921600000",
"number": "1083067870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "228 W SHORE DR",
"city": "MARBLEHEAD",
"state": "MA",
"postal_code": "019451322",
"telephone_number": "202-802-7337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 CENTRAL ST STE 111",
"city": "SALEM",
"state": "MA",
"postal_code": "019703752",
"telephone_number": "617-636-6591"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ GUSMAO",
"first_name": "ILENIA",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-18",
"last_updated": "2023-08-25",
"certification_date": "2023-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MA",
"license": "DN1859794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.