Provider Demographics
NPI:1568803385
Name:GOLOMB, ALYSON SHARI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:SHARI
Last Name:GOLOMB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 TRISMEN TER
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3950
Mailing Address - Country:US
Mailing Address - Phone:480-227-1000
Mailing Address - Fax:
Practice Address - Street 1:3727 N GOLDENROD RD
Practice Address - Street 2:108
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8611
Practice Address - Country:US
Practice Address - Phone:407-671-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist