Provider Demographics
NPI:1508941030
Name:GOLDEN, WILLIAM GLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GLEN
Last Name:GOLDEN
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 1:305 W 12TH AVE
Mailing Address - Street 2:#191, PO BOX 182357
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-2357
Mailing Address - Country:US
Mailing Address - Phone:614-292-5162
Mailing Address - Fax:614-292-9422
Practice Address - Street 1:305 W 12TH AVE
Practice Address - Street 2:#191
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43218-2357
Practice Address - Country:US
Practice Address - Phone:614-292-5162
Practice Address - Fax:614-292-9422
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0207681223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics