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General NPI Number Information
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NPI Number | 1134136286
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Entity Type | Organization
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Legal Business Name | GOLD ORTHODONTICS, P.C.
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1550 E HERITAGE PARK ST STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-5886
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Country | US
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Telephone | 208-884-5556
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Fax | 208-884-4041
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Provider Business Mailing Address
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Address Line | 1550 E HERITAGE PARK ST STE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-5886
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Country | US
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Telephone | 208-884-5556
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Fax | 208-884-4041
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL LYNN GOLD
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Credential | D.M.D.
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Telephone | 208-884-5556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D-3489-OR
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License Number State | ID
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