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General NPI Number Information
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NPI Number | 1376908160
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Entity Type | Organization
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Legal Business Name | JEFFREY GOLDER D.D.S. P.C.
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 4800 W SMITH VALLEY RD STE K
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City | GREENWOOD
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State | IN
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Zip | 46142-9198
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Country | US
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Telephone | 317-882-7800
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Fax | 317-883-3098
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Provider Business Mailing Address
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Address Line | 4800 W SMITH VALLEY RD STE K
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City | GREENWOOD
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State | IN
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Zip | 46142-9198
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Country | US
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Telephone | 317-882-7800
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Fax | 317-883-3098
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY GOLDER
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Credential | D.D.S.
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Telephone | 317-882-7800
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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 | 12009171
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License Number State | IN
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