Provider Demographics
NPI:1669645388
Name:GOLD, MICHAEL L (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:GOLD
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1550 E HERITAGE PARK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5886
Mailing Address - Country:US
Mailing Address - Phone:208-884-5556
Mailing Address - Fax:208-884-4041
Practice Address - Street 1:1550 E HERITAGE PARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5886
Practice Address - Country:US
Practice Address - Phone:208-884-5556
Practice Address - Fax:208-884-4041
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDD-3489-OR1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics