Provider Demographics
NPI:1114462140
Name:GOFS MCDONOUGH LLC
Entity Type:Organization
Organization Name:GOFS MCDONOUGH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHROKH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHERI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:678-905-9066
Mailing Address - Street 1:1880 W OAK PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2272
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 WESTRIDGE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9098
Practice Address - Country:US
Practice Address - Phone:678-304-6494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty