Provider Demographics
NPI:1427273457
Name:GOLE DENTAL GROUP
Entity type:Organization
Organization Name:GOLE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-948-2244
Mailing Address - Street 1:121 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1033
Mailing Address - Country:US
Mailing Address - Phone:269-948-2244
Mailing Address - Fax:269-948-2284
Practice Address - Street 1:121 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1033
Practice Address - Country:US
Practice Address - Phone:269-948-2244
Practice Address - Fax:269-948-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010112981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50868645192Medicare UPIN