Provider Demographics
NPI:1831504075
Name:GOULD, ALEX (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:GOULD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-0207
Mailing Address - Country:US
Mailing Address - Phone:231-832-9912
Mailing Address - Fax:231-832-5615
Practice Address - Street 1:4909 N PARK ST
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-7505
Practice Address - Country:US
Practice Address - Phone:231-832-9912
Practice Address - Fax:231-832-5165
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist