Healthcare Provider Details

I. General information

NPI: 1528277902
Provider Name (Legal Business Name): DOUGLAS WARREN GOFF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 TREMONT RD
COLUMBUS OH
43221-2111
US

IV. Provider business mailing address

3360 TREMONT RD
COLUMBUS OH
43221-2111
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-1300
  • Fax: 614-538-2490
Mailing address:
  • Phone: 614-451-1300
  • Fax: 614-538-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number17556
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: