Provider Demographics
NPI:1194873869
Name:GOLUB, BURTON MARC (DDS)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:MARC
Last Name:GOLUB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 MOKENA CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-5659
Mailing Address - Country:US
Mailing Address - Phone:727-849-8060
Mailing Address - Fax:
Practice Address - Street 1:12427 CLOCK TOWER PKWY
Practice Address - Street 2:
Practice Address - City:BAYONET POINT
Practice Address - State:FL
Practice Address - Zip Code:34667-2411
Practice Address - Country:US
Practice Address - Phone:727-868-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice