Provider Demographics
NPI:1073835120
Name:GAGOH FAMILY DENTAL
Entity Type:Organization
Organization Name:GAGOH FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:GAGOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-350-3366
Mailing Address - Street 1:24450 EVERGREEN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5518
Mailing Address - Country:US
Mailing Address - Phone:248-350-3366
Mailing Address - Fax:248-350-0457
Practice Address - Street 1:24450 EVERGREEN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5518
Practice Address - Country:US
Practice Address - Phone:248-350-3366
Practice Address - Fax:248-350-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty