Healthcare Provider Details

I. General information

NPI: 1255491643
Provider Name (Legal Business Name): JOEL GOLUB DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 MONTGOMERY RD
CINCINNATI OH
45242-7248
US

IV. Provider business mailing address

9505 MONTGOMERY RD
CINCINNATI OH
45242-7248
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-0660
  • Fax:
Mailing address:
  • Phone: 513-891-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: