MEDICARE: DR. WILLIAM GLEN GOLDEN 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	1223P0700X	Prosthodontics	30.020768	OH

General Provider Information

NPI Number	:	1508941030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM GLEN GOLDEN DDS

Provider Business Mailing Address
First Line	:	305 W 12TH AVE
Second Line	:	#191, PO BOX 182357
City	:	COLUMBUS
State	:	OH
Zip	:	43218-2357
Country	:	US
Telephone Number	:	614-292-5162
Fax Number	:	614-292-9422

Provider Business Practice Location Address
First Line	:	305 W 12TH AVE
Second Line	:	#191
City	:	COLUMBUS
State	:	OH
Zip	:	43218-2357
Country	:	US
Telephone Number	:	614-292-5162
Fax Number	:	614-292-9422

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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