Provider Demographics
NPI:1922201672
Name:GOSEN, ALBERT JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JOHN
Last Name:GOSEN
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 1:744 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204
Mailing Address - Country:US
Mailing Address - Phone:908-241-1800
Mailing Address - Fax:908-241-1270
Practice Address - Street 1:744 GALLOPING HILL RD
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204
Practice Address - Country:US
Practice Address - Phone:908-241-1800
Practice Address - Fax:908-241-1270
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ8826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist