Carl John Gimbrone Jr., D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN1855572 Issued in MA

Practice address

19 Tacoma St
Worcester, MA 01605-3516

Phone

(508) 854-3255

Fax

(508) 853-8593

NPI assigned

Jan 20, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1295481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401148800000",
    "number": "1912202169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052060",
            "telephone_number": "508-532-7318",
            "fax_number": "508-853-8593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 TACOMA ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016053516",
            "telephone_number": "508-854-3255",
            "fax_number": "508-853-8593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIMBRONE",
        "first_name": "CARL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-20",
        "last_updated": "2014-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1855572",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CT",
            "license": "10443",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Michelle Gilmartin
• Samantha Gilmore
• Sean Gilmore, PHARM D.
• Melissa Gilson
• Nicole M Gilson, NP
• Caroline Gingo
• Courtney Gingras
• Elizabeth Anne Gingras, PA
• Kelsey Dawn Gingras, DPT
• Rebecca Leigh Gingrich

• Dentist in Worcester, MA
• Providers in Worcester, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.