Individual
DR. MARK LEONARD GONSEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
131 E BROAD ST, EUFAULA, AL 36027-2023
(334) 687-3752
(334) 687-3802
Mailing address
131 E BROAD ST, EUFAULA, AL 36027-2023
(334) 687-3752
(334) 687-3802
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4228
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31737
BC/BS PROVIDER NUMBER
AL
01
—
836157
PROVIDER NUMBER
AL
Enumeration date
01/05/2006
Last updated
07/09/2007
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