Provider Demographics
NPI:1912016981
Name:GOLE, DANIEL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:GOLE
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 1:121 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1033
Mailing Address - Country:US
Mailing Address - Phone:269-948-2244
Mailing Address - Fax:269-948-2284
Practice Address - Street 1:121 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1033
Practice Address - Country:US
Practice Address - Phone:269-948-2244
Practice Address - Fax:269-948-2284
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010112981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50868645192Medicare ID - Type Unspecified