Provider Demographics
NPI:1275648263
Name:GOUGEON, KAREN JOAN (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JOAN
Last Name:GOUGEON
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:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-0016
Mailing Address - Country:US
Mailing Address - Phone:989-662-6061
Mailing Address - Fax:989-662-2676
Practice Address - Street 1:702 W MIDLAND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-0016
Practice Address - Country:US
Practice Address - Phone:989-662-6061
Practice Address - Fax:989-662-2676
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist