MEDICARE: DR. JONATHAN J GOLAB DDS, PA

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	18916	TX

General Provider Information

NPI Number	:	1881715753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN J GOLAB DDS, PA

Provider Business Mailing Address
First Line	:	3020 BROADMOOR LN
Second Line	:	STE. 100
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2703
Country	:	US
Telephone Number	:	972-691-1700
Fax Number	:	972-691-8269

Provider Business Practice Location Address
First Line	:	3020 BROADMOOR LN STE 100
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2705
Country	:	US
Telephone Number	:	469-444-2119
Fax Number	:	972-691-8269

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	01/23/2024

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