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General NPI Number Information
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NPI Number | 1316347131
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Entity Type | Individual
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Provider Name | LAURA MARIE GOLL D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 4453 HGWY B
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City | LAND O LAKES
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State | WI
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Zip | 54540-9705
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Country | US
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Telephone | 715-547-3541
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Fax |
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Provider Business Mailing Address
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Address Line | 4453 HGWY B
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City | LAND O LAKES
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State | WI
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Zip | 54540-9705
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Country | US
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Telephone | 608-335-7109
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1000973-15
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License Number State | WI
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