Provider Demographics
NPI:1144999806
Name:GOLDENT INC
Entity type:Organization
Organization Name:GOLDENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTISIT
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-774-4930
Mailing Address - Street 1:18121 GEORGIA AVENUE #108
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-774-4930
Mailing Address - Fax:301-774-4937
Practice Address - Street 1:18121 GEORGIA AVENUE #108
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-774-4930
Practice Address - Fax:301-774-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058460600Medicaid