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General NPI Number Information
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NPI Number | 1669777199
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Entity Type | Organization
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Legal Business Name | GOROSKI DENTAL CORPORATION
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 1036 VINE ST
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City | PASO ROBLES
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State | CA
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Zip | 93446-2559
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Country | US
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Telephone | 805-238-9581
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Fax | 805-238-5655
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Provider Business Mailing Address
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Address Line | 1036 VINE ST
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City | PASO ROBLES
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State | CA
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Zip | 93446-2559
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Country | US
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Telephone | 805-238-9581
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Fax | 805-238-5655
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK JOHN GOROSKI
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Credential | DDS
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Telephone | 805-238-9581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 53066
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License Number State | CA
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