Provider Demographics
NPI:1174274500
Name:GOLDEN GATE DENTAL INC
Entity Type:Organization
Organization Name:GOLDEN GATE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JONKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-699-1328
Mailing Address - Street 1:200 N WASHINGTON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4555
Mailing Address - Country:US
Mailing Address - Phone:630-983-6605
Mailing Address - Fax:
Practice Address - Street 1:200 N WASHINGTON ST STE 102
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4555
Practice Address - Country:US
Practice Address - Phone:630-983-6605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental