Provider Demographics
NPI:1497870919
Name:GO, SATOSHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:SATOSHI
Middle Name:
Last Name:GO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E MOYAMENSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1931
Mailing Address - Country:US
Mailing Address - Phone:215-462-4047
Mailing Address - Fax:208-498-4047
Practice Address - Street 1:1701 E MOYAMENSING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1931
Practice Address - Country:US
Practice Address - Phone:215-462-4047
Practice Address - Fax:208-498-4047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015859150002Medicaid