Healthcare Provider Details

I. General information

NPI: 1003300435
Provider Name (Legal Business Name): VEENA GOSAI FARMER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VEENA MANHAR GOSAI DMD

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 COUNTRY CLUB RD
JACKSONVILLE NC
28546-6005
US

IV. Provider business mailing address

3445 HENDERSON DR
JACKSONVILLE NC
28546-5233
US

V. Phone/Fax

Practice location:
  • Phone: 910-346-2345
  • Fax:
Mailing address:
  • Phone: 910-347-1283
  • Fax: 910-347-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN23506
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12790
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: