Provider Demographics
NPI:1598876922
Name:GOBER, JOHN RALSTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RALSTON
Last Name:GOBER
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 1:1309 SOMERSET CT
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4280
Mailing Address - Country:US
Mailing Address - Phone:817-577-0816
Mailing Address - Fax:
Practice Address - Street 1:5708 COLLEYVILLE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6064
Practice Address - Country:US
Practice Address - Phone:817-428-8575
Practice Address - Fax:817-577-3970
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0911752002Medicaid