Provider Demographics
NPI:1417170739
Name:GOLIA, ROBERT T (DDS, FAGD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:GOLIA
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 WHITNEY AVE
Mailing Address - Street 2:HAMDEN CENTER SUITE 1-C
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3509
Mailing Address - Country:US
Mailing Address - Phone:203-248-7400
Mailing Address - Fax:203-248-5310
Practice Address - Street 1:2319 WHITNEY AVE
Practice Address - Street 2:HAMDEN CENTER SUITE 1-C
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3509
Practice Address - Country:US
Practice Address - Phone:203-248-7400
Practice Address - Fax:203-248-5310
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT59621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice