Healthcare Provider Details

I. General information

NPI: 1083063754
Provider Name (Legal Business Name): NICHOLAS T GOLBA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANISTIQUE TRIBAL HEALTH CENTER 5698 W US-2
MANISTIQUE MI
49854
US

IV. Provider business mailing address

301 EXPLORER ST
GWINN MI
49841-2813
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-8469
  • Fax: 906-372-3230
Mailing address:
  • Phone: 906-483-1177
  • Fax: 906-372-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901021897
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: