Provider Demographics
NPI:1043386253
Name:MARK J GOCH DDS PC
Entity Type:Organization
Organization Name:MARK J GOCH DDS PC
Other - Org Name:CANTON DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-479-5425
Mailing Address - Street 1:230 RIVERSTONE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:770-479-5425
Mailing Address - Fax:770-479-0291
Practice Address - Street 1:230 RIVERSTONE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-479-5425
Practice Address - Fax:770-479-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental