Provider Demographics
NPI:1215041561
Name:GOGOL-MACH, DOROTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:GOGOL-MACH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EMBARCADERO CTR
Mailing Address - Street 2:LOBBY LEVEL / DENTAL OFFICE
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5900
Mailing Address - Country:US
Mailing Address - Phone:415-576-9800
Mailing Address - Fax:415-576-1345
Practice Address - Street 1:4 EMBARCADERO CTR
Practice Address - Street 2:LOBBY LEVEL / DENTAL OFFICE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5900
Practice Address - Country:US
Practice Address - Phone:415-576-9800
Practice Address - Fax:415-576-1345
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice