Provider Demographics
NPI:1255445284
Name:GOLAS, PAUL WALTER (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WALTER
Last Name:GOLAS
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 1:262 DERRY RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03052-2633
Mailing Address - Country:US
Mailing Address - Phone:603-880-4040
Mailing Address - Fax:603-883-7779
Practice Address - Street 1:262 DERRY RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:NH
Practice Address - Zip Code:03052-2633
Practice Address - Country:US
Practice Address - Phone:603-880-4040
Practice Address - Fax:603-883-7779
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice