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General NPI Number Information
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NPI Number | 1699514653
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Entity Type | Organization
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Legal Business Name | GOLD DENTAL CARE, LLC
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 530 E MAIN ST
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City | RICHMOND
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State | VA
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Zip | 23219-2418
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Country | US
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Telephone | 804-648-1305
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Fax |
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Provider Business Mailing Address
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Address Line | 63 W PROSPECT ST
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City | E BRUNSWICK
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State | NJ
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Zip | 08816-5705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | AHMAD HAWWA
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Credential | DDS
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Telephone | 310-995-0492
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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 |
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License Number State |
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