Provider Demographics
NPI:1164609129
Name:GOLPA, MIKE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:M
Last Name:GOLPA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 MEDICAL CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2402
Mailing Address - Country:US
Mailing Address - Phone:702-641-7111
Mailing Address - Fax:702-891-0102
Practice Address - Street 1:6420 MEDICAL CENTER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2402
Practice Address - Country:US
Practice Address - Phone:702-641-7111
Practice Address - Fax:702-891-0102
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist