MEDICARE: DR. GEOFFREY L GOLD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14082	OH

General Provider Information

NPI Number	:	1003925249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY L GOLD DDS

Provider Business Mailing Address
First Line	:	2230 DIXIE HWY
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45015-1698
Country	:	US
Telephone Number	:	513-863-1141
Fax Number	:	513-863-2420

Provider Business Practice Location Address
First Line	:	2230 DIXIE HWY
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45015-1698
Country	:	US
Telephone Number	:	513-863-1141
Fax Number	:	513-863-2420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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