Provider Demographics
NPI:1659816254
Name:JAVOD K GOL DDS PC
Entity Type:Organization
Organization Name:JAVOD K GOL DDS PC
Other - Org Name:PRECISION DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVOD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZEMIZADEH GOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-884-0262
Mailing Address - Street 1:8850 COLUMBIA 100 PKWY
Mailing Address - Street 2:SUITE 312
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2374
Mailing Address - Country:US
Mailing Address - Phone:410-884-0262
Mailing Address - Fax:410-884-0263
Practice Address - Street 1:8850 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 312
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2374
Practice Address - Country:US
Practice Address - Phone:410-884-0262
Practice Address - Fax:410-884-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD154171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty