NPIMap

Organization Active NPI

Glicksman-Gomes, LLC

  • Dentist
  • Dartmouth, MA
National Provider Identifier
1427465368
Registry record updated Jul 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN21610 Issued in MA
Legal business name
GLICKSMAN-GOMES, LLC
Practice address
49 State Road Nauset BLDG.
Dartmouth, MA 02747
Phone
(508) 999-2234
NPI assigned
Jul 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marly J. Gomes, DMD
Title
Owner
Phone
(508) 999-2234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DN21610 MA Primary

Addresses

Primary practice location

49 State Road Nauset BLDG.
Dartmouth, MA 02747

Mailing address

49 State Road Nauset BLDG.
Dartmouth, MA 02747
Phone (508) 999-2234

Other identifiers 1

IdentifierTypeStateIssuer
110076658AMedicaidMA

National Provider Directory

National Provider Directory
Tax ID family
Drmilton Aglicksman and Drmarly Gomes2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405036800000",
    "number": "1427465368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 STATE ROAD NAUSET BLDG.",
            "city": "DARTMOUTH",
            "state": "MA",
            "postal_code": "02747",
            "telephone_number": "508-999-2234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 STATE ROAD NAUSET BLDG.",
            "city": "DARTMOUTH",
            "state": "MA",
            "postal_code": "02747",
            "telephone_number": "508-999-2234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLICKSMAN-GOMES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-11",
        "last_updated": "2014-07-11",
        "status": "A",
        "authorized_official_last_name": "GOMES",
        "authorized_official_first_name": "MARLY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-999-2234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN21610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110076658A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dartmouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.