Provider Demographics
NPI:1114930310
Name:MARK E GOLUB DDS PLC
Entity Type:Organization
Organization Name:MARK E GOLUB DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-765-3366
Mailing Address - Street 1:1451 BELLE HAVEN RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307
Mailing Address - Country:US
Mailing Address - Phone:703-765-3366
Mailing Address - Fax:703-765-1419
Practice Address - Street 1:1451 BELLE HAVEN RD
Practice Address - Street 2:SUITE 340
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307
Practice Address - Country:US
Practice Address - Phone:703-765-3366
Practice Address - Fax:703-765-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty