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General NPI Number Information
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NPI Number | 1295798650
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Entity Type | Individual
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Provider Name | A.J. GOLLOFON DDS
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Gender | Male
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 11285 LAKE CITY WAY NE
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City | SEATTLE
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State | WA
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Zip | 98125-6718
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Country | US
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Telephone | 206-363-7200
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Fax | 206-367-8869
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Provider Business Mailing Address
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Address Line | 11285 LAKE CITY WAY NE
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City | SEATTLE
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State | WA
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Zip | 98125-6718
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Country | US
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Telephone | 206-363-7200
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Fax | 206-367-8869
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00006208
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License Number State | WA
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