Healthcare Provider Details

I. General information

NPI: 1831416767
Provider Name (Legal Business Name): DB PRACTICE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 ESSEX ST
LAWRENCE MA
01840
US

IV. Provider business mailing address

488 ESSEX STREET
LAWRENCE MA
01840
US

V. Phone/Fax

Practice location:
  • Phone: 978-975-8888
  • Fax: 978-291-0097
Mailing address:
  • Phone: 978-975-8888
  • Fax: 978-291-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22028
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN22028
License Number StateMA

VIII. Authorized Official

Name: MR. DARIO GONZALEZ
Title or Position: VICE PRESIDENT/PERIODONTIST
Credential: DMD
Phone: 617-519-6199