Provider Demographics
NPI:1609814540
Name:GHOLSON, DAN J (DDS)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:J
Last Name:GHOLSON
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 1:2850 MIDWEST DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-6732
Mailing Address - Country:US
Mailing Address - Phone:608-782-0140
Mailing Address - Fax:608-785-7610
Practice Address - Street 1:2850 MIDWEST DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6732
Practice Address - Country:US
Practice Address - Phone:608-782-0140
Practice Address - Fax:608-785-7610
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics