Healthcare Provider Details

I. General information

NPI: 1386757458
Provider Name (Legal Business Name): MONICA A GOBRAN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HARVARD ST
WORCESTER MA
01609-2839
US

IV. Provider business mailing address

11 HARVARD ST
WORCESTER MA
01609-2839
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-3200
  • Fax: 508-753-1894
Mailing address:
  • Phone: 508-753-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21325
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MONICA AYOUB GOBRAN
Title or Position: PRESIDENT
Credential: DMD
Phone: 508-753-3200