Provider Demographics
NPI:1588775274
Name:GOLE, JASON DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DANIEL
Last Name:GOLE
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 1:121 WEST WOOD LAWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058
Mailing Address - Country:US
Mailing Address - Phone:269-948-2244
Mailing Address - Fax:269-948-2284
Practice Address - Street 1:121 WEST WOOD LAWN AVENUE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058
Practice Address - Country:US
Practice Address - Phone:269-948-2244
Practice Address - Fax:269-948-2284
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010184251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice