Provider Demographics
NPI:1376574244
Name:GOSZTOLA, GEORGE JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JAMES
Last Name:GOSZTOLA
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 1:940 N. CENTRAL
Mailing Address - Street 2:SUITE C
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032
Mailing Address - Country:US
Mailing Address - Phone:253-854-3650
Mailing Address - Fax:253-854-0513
Practice Address - Street 1:940 N. CENTRAL
Practice Address - Street 2:SUITE C
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032
Practice Address - Country:US
Practice Address - Phone:253-854-3650
Practice Address - Fax:253-854-0513
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000086981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice