Provider Demographics
NPI:1104970110
Name:GOULD, ROXANNE (DDS)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11458 TUNNEL HILL WAY
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7224
Mailing Address - Country:US
Mailing Address - Phone:916-638-3033
Mailing Address - Fax:
Practice Address - Street 1:530 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4525
Practice Address - Country:US
Practice Address - Phone:714-571-3681
Practice Address - Fax:714-571-3688
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist