MEDICARE: DR. PHILLIP DAVID GOULD DMD

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	DGD.8934	SC

General Provider Information

NPI Number	:	1962923888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP DAVID GOULD DMD

Provider Business Mailing Address
First Line	:	127 HUNTS BRIDGE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1623
Country	:	US
Telephone Number	:	864-246-6471
Fax Number	:	864-246-9917

Provider Business Practice Location Address
First Line	:	127 HUNTS BRIDGE RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1623
Country	:	US
Telephone Number	:	864-246-6471
Fax Number	:	864-246-9917

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

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	11/04/2021

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