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General NPI Number Information
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NPI Number | 1194775809
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Entity Type | Individual
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Provider Name | JOSEPH H GOTH III DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 980 BEAVER GRADE RD
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City | MOON TOWNSHIP
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State | PA
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Zip | 15108-2774
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Country | US
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Telephone | 412-262-5091
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Fax | 412-262-1090
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Provider Business Mailing Address
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Address Line | 980 BEAVER GRADE RD
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City | MOON TOWNSHIP
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State | PA
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Zip | 15108-2774
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Country | US
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Telephone | 412-262-5091
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Fax | 412-262-1090
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS020845L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | MD033127E
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License Number State | PA
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