Individual
MRS. ILENIA ELIZABETH GONZALEZ GUSMAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20 CENTRAL ST STE 111, SALEM, MA 01970-3752
(617) 636-6591
Mailing address
228 W SHORE DR, MARBLEHEAD, MA 01945-1322
(202) 802-7337
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
DN1859794
MA
Other
Enumeration date
07/18/2016
Last updated
08/25/2023
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