Healthcare Provider Details

I. General information

NPI: 1568551737
Provider Name (Legal Business Name): MELVYN GOLDEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 OLD ABE RD
LAC DU FLAMBEAU WI
54538-9682
US

IV. Provider business mailing address

450 OLD ABE RD
LAC DU FLAMBEAU WI
54538-9682
US

V. Phone/Fax

Practice location:
  • Phone: 715-588-3371
  • Fax: 715-588-7884
Mailing address:
  • Phone: 715-588-3371
  • Fax: 715-588-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3623
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: