Provider Demographics
NPI:1265064976
Name:ALEX T GOULD DMD PLC
Entity type:Organization
Organization Name:ALEX T GOULD DMD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:231-832-9912
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-0207
Mailing Address - Country:US
Mailing Address - Phone:231-832-9912
Mailing Address - Fax:231-832-5165
Practice Address - Street 1:4909 N PARK ST
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-7505
Practice Address - Country:US
Practice Address - Phone:231-832-9912
Practice Address - Fax:231-832-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty