Healthcare Provider Details

I. General information

NPI: 1669777199
Provider Name (Legal Business Name): GOROSKI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 VINE ST
PASO ROBLES CA
93446-2559
US

IV. Provider business mailing address

1036 VINE ST
PASO ROBLES CA
93446-2559
US

V. Phone/Fax

Practice location:
  • Phone: 805-238-9581
  • Fax: 805-238-5655
Mailing address:
  • Phone: 805-238-9581
  • Fax: 805-238-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number53066
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICK JOHN GOROSKI
Title or Position: OWNER
Credential: DDS
Phone: 805-238-9581