Provider Demographics
NPI:1003925249
Name:GOLD, GEOFFREY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:L
Last Name:GOLD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1698
Mailing Address - Country:US
Mailing Address - Phone:513-863-1141
Mailing Address - Fax:513-863-2420
Practice Address - Street 1:2230 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1698
Practice Address - Country:US
Practice Address - Phone:513-863-1141
Practice Address - Fax:513-863-2420
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice