Provider Demographics
NPI:1669686267
Name:GOBER, RALSTON B (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:RALSTON
Middle Name:B
Last Name:GOBER
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3779
Mailing Address - Country:US
Mailing Address - Phone:903-872-1661
Mailing Address - Fax:903-872-1731
Practice Address - Street 1:1115 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3779
Practice Address - Country:US
Practice Address - Phone:903-872-1661
Practice Address - Fax:903-872-1731
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice