MEDICARE: DR. MICHAEL JOSEPH GOULDING D.D.S.

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	14306	TX

General Provider Information

NPI Number	:	1609870955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH GOULDING D.D.S.

Provider Business Mailing Address
First Line	:	3600 HULEN ST
Second Line	:	STE D3
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6872
Country	:	US
Telephone Number	:	817-737-3536
Fax Number	:	817-737-3689

Provider Business Practice Location Address
First Line	:	3600 HULEN ST
Second Line	:	STE D3
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6872
Country	:	US
Telephone Number	:	817-737-3536
Fax Number	:	817-737-3689

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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