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General NPI Number Information
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NPI Number | 1235396979
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Entity Type | Organization
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Legal Business Name | ALAN M. GONICK, D.M.D., PC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 122 KENOZA AVE
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City | HAVERHILL
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State | MA
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Zip | 01830-4139
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Country | US
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Telephone | 978-374-7942
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Fax | 978-374-2475
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Provider Business Mailing Address
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Address Line | 122 KENOZA AVE
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City | HAVERHILL
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State | MA
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Zip | 01830-4139
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Country | US
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Telephone | 978-374-7942
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Fax | 978-374-2475
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN M. GONICK
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Credential | D.M.D.
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Telephone | 978-374-7942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 18074
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License Number State | MA
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