Provider Demographics
NPI:1568858215
Name:DOUGLAS W GOFF DDS LLC
Entity Type:Organization
Organization Name:DOUGLAS W GOFF DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-451-1300
Mailing Address - Street 1:3360 TREMONT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2111
Mailing Address - Country:US
Mailing Address - Phone:614-451-1300
Mailing Address - Fax:614-451-1300
Practice Address - Street 1:3360 TREMONT RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2111
Practice Address - Country:US
Practice Address - Phone:614-451-1300
Practice Address - Fax:614-451-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.017556261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental