Mikhail Gomer DMD PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21083 Issued in MA

Legal business name

MIKHAIL GOMER DMD PC

Doing business as

Mount Vernon Dental Solutions

Practice address

525 South Broadway
Lawrence, MA 01843-2837

Phone

(978) 682-0641

Fax

(978) 682-0644

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mikhail Gomer, DMD

Title

Owner

Phone

(978) 682-0641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mount Vernon Dental Solutions Doing business as

Locations

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437696000000",
    "number": "1639207475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 SOUTH BROADWAY",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018432837",
            "telephone_number": "978-682-0641",
            "fax_number": "978-682-0644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 SOUTH BROADWAY",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018432837",
            "telephone_number": "978-682-0641",
            "fax_number": "978-682-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKHAIL GOMER DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2015-07-24",
        "status": "A",
        "authorized_official_last_name": "GOMER",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-682-0641",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "21083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9747401",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Vernon Dental Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Terra Mikalson, LCSW
• Mai T Milan, CNP
• Christina Miller, M. ED., MSW, LICSW
• Crystal Ann Miller
• Hannah Plum Miller, LICSW
• Robert A Miller, MD

• General Practice Dentistry in Lawrence, MA
• Providers in Lawrence, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; 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.