Healthcare Provider Details

I. General information

NPI: 1508941030
Provider Name (Legal Business Name): WILLIAM GLEN GOLDEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE #191
COLUMBUS OH
43218-2357
US

IV. Provider business mailing address

305 W 12TH AVE #191, PO BOX 182357
COLUMBUS OH
43218-2357
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-5162
  • Fax: 614-292-9422
Mailing address:
  • Phone: 614-292-5162
  • Fax: 614-292-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number30.020768
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: