Healthcare Provider Details

I. General information

NPI: 1255827887
Provider Name (Legal Business Name): ARIELLE MONIECE GOLDEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3646 MOUNT ELLIOTT ST
DETROIT MI
48207-2311
US

IV. Provider business mailing address

22955 INKSTER RD
FARMINGTON HILLS MI
48336-3843
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-3435
  • Fax:
Mailing address:
  • Phone: 313-207-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901022603
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: