Healthcare Provider Details

I. General information

NPI: 1568858215
Provider Name (Legal Business Name): DOUGLAS W GOFF DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
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: 614-451-1300
Mailing address:
  • Phone: 614-451-1300
  • Fax: 614-451-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number30.017556
License Number StateOH

VIII. Authorized Official

Name: DR. DOUGLAS W GOFF
Title or Position: OWNER
Credential: DDS
Phone: 614-451-1300