Provider Demographics
NPI:1609195619
Name:GOLIK, BLAZEJ WOJCIECH (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAZEJ
Middle Name:WOJCIECH
Last Name:GOLIK
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 1:4355 SUWANEE DAM RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6707
Mailing Address - Country:US
Mailing Address - Phone:770-614-7300
Mailing Address - Fax:
Practice Address - Street 1:4355 SUWANEE DAM RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6707
Practice Address - Country:US
Practice Address - Phone:770-614-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009015911122300000X
GADN014135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist