Provider Demographics
NPI:1528269768
Name:GOLDING, MICHAEL WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:GOLDING
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 1:5050 N. 40TH STREET, #180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:602-957-0332
Mailing Address - Fax:602-957-3292
Practice Address - Street 1:5050 N. 40TH STREET, #180
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-957-0332
Practice Address - Fax:602-957-3292
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD078661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-1959423OtherTAX ID #