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General NPI Number Information
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NPI Number | 1881715753
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Entity Type | Individual
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Provider Name | JONATHAN J GOLAB DDS, PA
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 3020 BROADMOOR LN STE 100
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City | FLOWER MOUND
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State | TX
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Zip | 75022-2705
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Country | US
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Telephone | 469-444-2119
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Fax | 972-691-8269
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Provider Business Mailing Address
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Address Line | 3020 BROADMOOR LN STE. 100
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City | FLOWER MOUND
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State | TX
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Zip | 75022-2703
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Country | US
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Telephone | 972-691-1700
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Fax | 972-691-8269
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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 | 18916
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License Number State | TX
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