Provider Demographics
NPI:1710240536
Name:GOSTIGIAN, MICHAEL J (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GOSTIGIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 HANCOCK BRIDGE PKWY W STE A02
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2091
Mailing Address - Country:US
Mailing Address - Phone:239-573-1273
Mailing Address - Fax:239-573-1277
Practice Address - Street 1:106 HANCOCK BRIDGE PKWY W STE A02
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2091
Practice Address - Country:US
Practice Address - Phone:239-573-1273
Practice Address - Fax:239-573-1277
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist